HIV, the 'explosive epidemic': Fiji suffers world's fastest spread

Pacific Correspondent Barbara Dreaver investigates the rapidly increasing cases of HIV in Fiji, and what the country is doing to tackle the problem.

John* sits quietly, his skin is covered with scars from recently healed sores. He’s 16 but with a slight gaunt frame gives him the appearance of being so much younger, until you catch his eyes long enough to see they reflect a knowledge and tiredness someone his age just shouldn’t possess.

John has HIV, contracted from a contaminated needle while using meth. He had run away from his home in the village to escape a domestic violence situation and was living on the street when he first started taking the drug.

“I was sleeping there and big boys come and bring the needles,” he says. It was the police he says who took him to a hospital where he tested positive for HIV.

“I was angry,” he says when describing the moment he found out he had the virus. Up until then he had no idea how HIV spread. Now at a Salvation Army boys refuge in the capital Suva, he comes under the wing of Pastor Amani Waqetia who makes sure he takes his antivirals every day.

John is not alone- nearly half the boys here at the Youth Restoration Service Centre have HIV. The youngest as young as 12.

Pastor Waqetia says a lot of the youth who come through the centre use drugs without knowing the risks. Another common practice among them is ‘bluetoothing’ when someone shoots up with meth and then injects their blood into others to share a high.

“They’re just sharing needles. It really breaks my heart to see these young people knowing that they have all these infection on them that they will carry for life,” he says.

The figures and spread of HIV in Fiji is staggering. Just three years ago 245 new cases were reported in a year, but in 2024 there were 1583.

Those living with HIV is now estimated to sit at close to 9000, making it the fastest growing HIV epidemic in the world. The sudden spike is being blamed on methamphetamine, with around half of the new cases last year coming from injections.

But as it spreads, it’s evolving to the wider population. To people like Mary*, an intelligent vibrant professional, who says there are many myths and misconceptions about HIV in Fiji.

“Hardly anyone will think that HIV is impacting the Indo-Fijian community in Fiji but it is – I’m Indo-Fijian and I have HIV. A lot of people think only the LGBTQI community has HIV but I am straight. A lot of people think it’s only because of drugs people get it – I’ve never done any drugs in my entire life and still I got HIV.”

Mary says there needs to be more education around the disease due to the misinformation and stigma attached to it.

“I guess the reason I wanted to talk to you was, even if this one person, who was just newly diagnosed and they’re thinking they’re alone and going through this by themselves - I’ve been living with this for two years now and I’ve been undetectable for one and a half years.

“You’re not alone and you don’t have to die because this is something that you can survive and you can live with.”

Mary was 32 years old, single and dating, when she tested positive.

“I do have partners that I meet that I engage with [in a] consensual sexual relationship. And most of the time these men... don’t wear condoms - actually, majority of the time men in Fiji don’t wear condoms so that’s already risky behaviour,” she says.

Mary went with a group of her friends to get tested and was shocked at the confronting news.

“I really told my mum through text - me walking into the house after coming from the clinic with the result. She just gave me a hug and she said ‘we’ll get through this’.” That and the widespread support and love she got from her family made all the difference.

Mary’s biggest and most immediate fear was for her daughter.

“At the time I contracted HIV I was still breastfeeding my newborn baby so there was an immediate risk that I have transmitted HIV to my newborn,” she says. “There was no way I would have lived with myself knowing I had passed it on to her.”

Fortunately her daughter tested negative. Last year in Fiji, 41 children were diagnosed with HIV and eight died.

Mary says taking her antivirals every day, which she will have to do for the rest of her life, has saved her life but there have been stock shortages.

“I actually felt panic, like genuine panic, I had a full breakdown,” she says. She rang family overseas to see if she would be able to access her lifesaving treatment but the cost proved prohibitive.

Dr Jason Mitchell who runs Fiji’s national HIV taskforce admits there have been problems. “We’ll be mobilising additional human resources to help us understand the weaknesses in the procurement links so that we don’t end up with the situation that we often had in the past where we’ve had shortages around ARVs [anti-retrovirals]. So, yeah, so hopefully it’s a problem in the past,” he says.

But there’s another issue and it’s a big one. In Fiji less than a quarter of people who have HIV take the medication. Dr Mitchell says even though people are getting tested, a huge number never return to get their results.

“That’s what we are grappling with is that we’re only seeing half of the people that we’re actually diagnosing.”

It’s a Thursday night in Suva and the Medical Services Pacific (MSP) mobile clinic is setting up for business. Parked at the side of the road in a rougher part of town, staff have set up a tent which attaches to the mobile clinic door.

Those getting tested go inside the van as privacy is valued here. Out of the darkness people filter through - sex workers, drug users among them. They call this the “moonlight drive” where the clinic is taken to people who wouldn’t normally go to one.

MSP is a non-profit group funded by a number of donors focusing on sexual reproductive health and rights services – but HIV is currently its core activity. Clinical manager Sereana Bulivakorua says by using mobile clinics and outreaches in vulnerable communities, it has tested 4000 plus people since 2024.

“Before last year the turnaround time for testing is a week, even if they come in with symptomatic. For now, the success that we have, the result is dispatched within 15 minutes,” she says.

It’s not just about the testing – MSP provides pre- and post-medical counselling.

MSP’s Taniea Vinoka says wraparound services are important. “We are seeing people turning up for screening and it’s just alarming so when we design programmes we design programmes that will address the current crisis.”

That’s why the organisation is also about to roll out a school programme on HIV awareness.

But it’s clear the measures aren’t enough to counter the rapid spread in Fiji.

Renata Ram, based in Suva at the Joint United Nations Programme on HIV and AIDS (UNAIDS), says the Ministry of Health has done a lot of work strengthening their system before it can respond effectively.

“In term of HIV programming in Fiji and the Pacific, we’re 15 to 20 years behind the rest of the world. So we’re playing catchup while responding to an epidemic,” she says.

After years of inaction Fiji’s government is now moving quickly, committing $10 million into an HIV response and giving the nod to a needle exchange programme. The introduction of PrP (Pre-exposure Prophylaxis) - a preventative medication for those at high risk - is expected to be rolled out in some areas by the end of the year.

The sudden acceleration e is being applauded by those trying to make a difference.

Ram says bold leadership in a conservative country is what’s needed right now. “It took a long time to get the support that we needed, but it has changed dramatically”.

She says the Government is also pushing initiatives through, with the police wanting to be part of a harm reduction strategy.

“So a needle syringe programme is part of a harm reduction strategy we have. The Great Council of Chiefs that are behind this, we have faith-based leaders behind this, so a lot has changed,” she says.

New Zealand has also given $5 million dollars and High Commissioner to Fiji Charlotte Darlow says it’s important we partner up given the strong links between the two countries.

“Absolutely critical that we’re helping a country that has really clearly demonstrated that they are up for dealing with a considerable challenge that they want to understand how big the problem is and that they want to take clear measures to get on top of the outbreak,” she says.

Darlow says HIV is a big vulnerability not just for Fiji but the wider Pacific.

“If you have a health issue that surfaces in Fiji we have, as you’ll know, multiple flights a day between New Zealand and Fiji. We would be naive to think that it’s not also a health problem that we might see replicating across the border or out into the wider region,” she says.

The spread throughout the Pacific is something the UN is raising alarm bells about.

There are already signs HIV is on the rise around the region as the use of injected meth mounts. Fiji is offering to share the lessons it’s learned and the UN says the Pacific needs to listen.

“It is essential for them, it’s non negotiable. If they don’t then they will risk themselves to be Fiji,” Ram says. “What happens in Fiji doesn’t stay in Fiji and we’ve coined this term that no Pacific island is safe unless we all are safe”.

Heads of health around the region have already committed to a regional HIV plan. Pacific health ministers were meant to meet in Samoa where the issue was top of the agenda, however the meeting was cancelled because of the country’s snap election.

Mitchell, based at the Ministry of Health headquarters, knows he has a giant battle on his hands and is grim faced as he delivers a warning.

“I’m hoping that we address the current epidemic that we’re facing here in Fiji and we get to a situation where we are able to return to normal as it were, because the response that we’re having to mount is an emergency response and we can't exist in an emergency response forever.”

Those living with HIV in Fiji also have hopes of their own. Teenager John only has one, he says, and that’s to be reunited with family members he loves without feeling in danger. But for now he’s safe with the Salvation Army who have essentially saved his life with their care.

Mary, whose future is assured with a strong family at her side, wants to see sexual and reproductive health taught in schools - “we’re failing our kids by not teaching them this,” she says.

“I feel sad that something so preventable as HIV is still spreading when it can so easily be prevented. It’s the easiest thing in the world.”

* Names changed for their protection