Mothers and babies pay the price as Fiji's HIV emergency worsens

Pacific Correspondent Barbara Dreaver reports from Fiji on the devastating HIV crisis in the Pacific nation.

Each beep of the heart monitor machines in Fiji's biggest hospital's paediatric intensive care unit (PICU) signifies life.

But there is no guarantee for the three babies with HIV here.

It's a heartbreaking scene at Suva's Colonial War Memorial Hospital. Their little chests rise rapidly, the hand of one of the babies clenches and then unclenches. Someone has placed an open bible at the end of one of the incubators.

Next door in the antenatal intensive care unit (NICU) a nurse sits at each incubator quietly monitoring their tiny patients.

Exclusive: Children left to die as HIV runs rampant during Fiji's 'failure of society' - Watch on TVNZ+

Life and death hover distressingly close together in these rooms.

Dr Priya Kaur, who leads Fiji's work on HIV mother to child transmission, says the country is now seeing something it's never seen before - people and babies with HIV who do not have "risky behaviours".

"We are seeing a generalised epidemic which is a very, very scary situation for any public health team or any country as a whole," she says.

Last year, of the 59 babies who were infected with HIV, only one mother was a drug user.

"I've had women who are widowed, their husbands have died and they only found out on the husband's death certificates that their husbands were living with HIV and then they (the women) got tested and they are positive and their children are positive," she says.

"So these are women who are pregnant who - very, very few of them had risky behaviours - and they still had a high prevalence of HIV amongst them."

This is a clear sign of how Fiji's deepening HIV crisis has moved from being fuelled primarily by its methamphetamine crisis - sharing blood and needles - to sexual transmission amongst the general population.

While the sharing of needles still plays a major role in the spread of HIV, medical authorities are clear it has spread beyond that.

It's why the Fiji Government has declared a public emergency.

Dr Jason Mitchell heads Fiji's HIV taskforce. He says that while last year's figures are bad enough - one in 60 adults are living with HIV - that is expected to be significantly worse this year.

Last year 118 people died with HIV, 18 of them babies.

"We are now describing this as a generalised epidemic, which means that it's no longer a problem within certain population groups and it's more widespread than it was thought to be initially," he says.

He says the projections are that up to 12,000 people will be living with HIV in Fiji by the end of the year and there are enormous challenges ahead.

"There are efforts here to take women to task for babies who have become positive HIV. We cannot blame an individual for what's happening to any child being infected. It's a failure of the system, it is a failure of society that allowed women to become positive in the first place and for a child to become infected."

He says another challenge is the "really damaging" misinformation and conspiracy theories that abound on social media, including that Covid vaccinations are responsible for the HIV crisis and that prayer and also traditional medicine cures HIV.

"It is really, really dangerous and it's not helpful, so for us we're spending our time trying to correct misinformation and there is a lot of that out there.

"My concern is that it's what we see that we can handle but there are so many closed groups, Viber groups, WhatsApp groups, messenger groups that are closed. Who knows what's being said on those and who knows who is believing what information is being circulated on that."

One of the latest to circulate on social media features a young Fijian woman holding bottles of traditional medicines saying it had cured her HIV.

These are serious issues given Fiji's measures to prevent and treat HIV have not expanded fast enough.

"So the way I describe it is that the epidemic is outpacing our interventions," says Dr Mitchell.

Frustration is written all over his face.

"We simply can't do enough prevention, we don't have enough people doing preventions, we also don't have an audience that is willing to go on those preventions.

"And of course you don't have enough people providing treatment and care in the country and then, even if you address it, you have all these people who don't want to be on treatment or who keep dropping out of it. As long as you have that, the epidemic will continue to rise."

One of the big issues in Fiji is only 22% of those with HIV are accessing lifesaving antiretroviral treatment though it is readily available.

The drugs, including testing kits and needles, are stored in a warehouse - funded by New Zealand - in an undisclosed urban part of Suva. We are told not to film outside in case the location is identified but inside we see boxes piled up and delivered to pharmacies and clinics.

There's no shortage of the antiretroviral drugs which, if taken correctly, has a more than 95% chance of making HIV completely undetectable. Also stored here is PrEP (pre-exposure prophylaxis)which is 99% effective in preventing HIV.

Little wonder there is frustration that less than a quarter of Fijians living with HIV are using these life-saving drugs.

There are complicated reasons why, including the fact most Fijians live in extended family situations and there's a deep rooted fear of being identified as HIV and ostracised by family.

Dr Kaur says because of stigma and discrimination around HIV, "families are breaking" when someone in the household gets a positive diagnosis.

Because of this they think, "I'd rather die than get tested and then I'll have to tell somebody or somebody at home will find out," she says.

Mark Shaheel Lal, founder of Living Positive Fiji and himself living with HIV, says many of the people who contact him are in a dangerous situation.

"I've had people who say they want to kill themselves, I've had some people who say, you know, it's a struggle to hide their meds from the family."

Cultural and religious factors also play a part.

"A lot of people in Fiji have no knowledge on sexual health. First of all the topic of sex in our country is a taboo, people feel uncomfortable talking about it."

A mother living with HIV who wants to remain unidentified agrees.

"The biggest barrier is our faith, our culture, tradition and just a lack of knowledge. We never received comprehensive sexuality education in school," she says.

She became infected after having unprotected sex - and she knows women across Fiji are bearing the brunt of the HIV crisis.

"I think it should be a crime, it should be a sexual crime for any man to pass on HIV to their partners. Women cannot negotiate condom use in the country. We are not at fault because if you look at our culture if you ask a man to wear condoms there's the allegation you are cheating on them," she says.

Both she and Mark Lal believe the government has dropped the ball in terms of past action against HIV, and the declaration of a "national emergency" is a bit late.

However there is no doubt the national emergency has fast-tracked interventions.

Legislation is expected to be passed enabling legal needle and syringe distribution so they aren't shared amongst those who are injecting drugs.

Dr Mitchell says it's not before time and it's an important move.

"We have had some slowness around the introduction of the needle syringe programme. It is a strategy that has been used in multiple countries around the world. Up to 92 countries around the world use needle and syringe programmes," he says.

Another initiative is the planned introduction of antiretroviral medication Lenacapavir before the end of the year.

According to Dr Mitchell this is a "gamechanger" as people living with HIV can get an injection once every six months instead of taking medication home and having it daily.

The Government has set up a five-minister cabinet subcommittee to expedite action and remove bureaucratic barriers.

The subcommittee is aware government cannot act alone. As well as medical authorities, it's working with others including churches and the Great Council of Chiefs.

With more than 1700 local churches throughout Fiji, Methodists make up the largest religious denomination.

Reverend Mosese Salusalu heads the church's social services division. When we visit, the church board has been meeting all day working out what action it can take given the national emergency and Reverend Salusalu looks weary.

"Members of our families, the church families, are also affected so that's why the church cannot just stand and watch and allow these people to die in vain," he says.

"So long we have been preaching from the pulpit and sometimes you shy away when it comes to sexually transmitted diseases, HIV. But we are so quick to judge people of this thing and I believe that is wrong."

One of the actions will be to take a team to church rallies held every month.

"This is where we can use this platform to get the specialists to talk about HIV," he says.

But what does the church think about the use of condoms as advocated by health authorities.

"As far as protection is concerned, not so much on that but along abstinence, abstinence only. But some people, they cannot control themselves so we tell them, I think the best option for use is condoms for protection," he says.

The Great Council of Chiefs is also planning on taking an active role, co-ordinated by its chairman Ratu Viliami Seruvakula.

A former military man, he worked with the United Nations Peace and Security Division for nearly two decades and he gets emotional when he speaks about Fiji's HIV crisis.

"I thought I've seen the worst in humanity. Like I said, I've worked in conflict countries around the world for the last 19 years I've spent with the United Nations, but to see in my homeland its heartbreaking," he says

What's concerning the Great Council of Chiefs (GCC), or Bose Levu Vakaturaga, is this crisis is terribly timed.

The traditional chiefly structure was suspended in 2007 by coup leader and dictator Voreqe Bainimarama, who considered it to wield too much power. He told chiefs at the time to "go drink homebrew under a mango tree". The GCC was then formally disbanded in 2012 before being reinstated by the current Government three years ago.

Ratu Viliami Seruvakula says the country has just come through a very difficult period of its history and the HIV crisis "couldn't have come at a worse time" as the nation rebuilds society, politics and the economy.

And the Great Council of Chiefs also has its own rebuilding to do after it was "dismantled systematically" by Bainimarama.

"Now when you dismantle that you have people going in every direction looking for answers and you have all these urban centres filled up because people cannot see the guidelines in the villages," he explains.

"Trust was broken in 16, 20 years because when you move away from norms of society by creating laws as you go along without proper consultation it breaks the trust and there's a lot of that has transpired over the years so we have a problem," he says.

Ratu Seruvakula says rebuilding trust is key so he travels to his village every Sunday, a 50km drive, to talk face to face with his people. It will be this model which the GCC uses to get the HIV prevention and treatment messaging out to "iTaukei" or indigenous Fijians. They plan on kicking this off in October.

"I've said (to the HIV taskforce), you come with me and we'll go down and talk to the people because we need to have an honest conversation. This is something you cannot just talk about it and hope that it's going to look after itself," he says.

Every chief will call his tribal leaders to tell them what needs to be done. "They will then go and talk to the clans and then the clans to the sub-clans and things will get done."

They also plan to bring traditional leaders from their respective provinces into the urban centres to speak with their people there.

Ratu Seruvakula is clear - the country has no choice.

"When you look at the statistics now it's quite obvious that we didn't really understand the gravity of this situation," he says.

The way ahead is grim - for the next few years at least.

Dr Mitchell says the cases will continue to rise before they plateau and then, hopefully, start to go down.

But a lot more babies will die before then.