HIV infections have risen sharply in Fiji over the last decade, with health officials warning the island nation now has the fastest-growing HIV epidemic in the world – driven by intravenous drug use, gaps in testing and treatment and persistent stigma around the virus.
After recording more than 1,000 new infections in 2024, in a population of 900,000, authorities in Fiji announced the launch of an HIV epidemic response plan and the implementation of a four-year HIV control strategy.
"Fiji has the fastest growing HIV epidemic in the world, which is very worrying," says Dr Mark Jacobs, representative of the World Health Organization (WHO) for the South Pacific, who is based in Fiji.
In its 2025 global report on AIDS, the Joint United Nations Programme on HIV/AIDS (UNAIDS), a sister agency of the WHO, estimated that the number of new HIV infections in Fiji has increased by 3,091 percent since 2010.
UNAIDS found that fewer than 500 people were living with HIV in the archipelago in 2014, a figure that jumped to more than 6,000 10 years later.
"In 2024, Fiji reported 1,583 new cases of HIV. In the first six months of 2025 alone, 1,226 people were newly diagnosed," Renata Ram, UNAIDS HIV advisor for the Pacific, told RFI. "The trajectory, already close to the previous year's total, is extremely worrying."
According to UNAIDS estimates, only 36 percent of people living with HIV in Fiji are aware of their HIV status and only 24 percent of them are receiving treatment.
"This is why Fiji is still a long way from meeting our targets," added Ram, citing the goal of 95 percent of carriers diagnosed, 95 percent of those treated and 95 percent of those treated achieving viral suppression by 2030.
Calls for needle exchange
A recent study commissioned by the Fijian Ministry of Health points to intravenous drug use as a major issue.
The study, conducted jointly by the Kirby Institute at the University of New South Wales in Australia, the National University of Fiji and the Australian Injecting and Illicit Drug Users League (AIVL) found that "among those surveyed who started HIV treatment in 2024, 48 percent were people who injected drugs, highlighting the disproportionate impact on this group".
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Jacobs told RFI: "Drug use has increased in Fiji in recent years, particularly the use of methamphetamine by injection. And this is happening at a time when it is very difficult to obtain clean needles and syringes".
Ram echoed this, saying: "The lack of availability of clean syringes leads to risky practices, especially when needles, syringes or other injection equipment are shared, or when injection is done in groups."
Following the publication of the results of the joint study, several experts called for the implementation of needle exchange programmes (NEPs) to ensure the availability of clean equipment and curb the risk of infection.
The Fijian government agreed to implement these recommendations. Minister of Health and Medical Services Atonio Lalabalavu said: "The national task force on the HIV epidemic and outbreak response, in collaboration with our international partners, is working to rapidly establish a needle and syringe distribution programme as part of our urgent public health response."
'Stigma and discrimination'
While transmission during sexual intercourse continues to contribute to the rise in new infections, so does mother-to-child transmission, when HIV is not detected or treated in time during pregnancy.
Jacobs says these situations can also be linked to cultural and societal barriers, as well as lack of knowledge about how to prevent HIV and the availability of effective medicines.
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"There are still issues of stigma and discrimination in the country, which may cause some people to hesitate to get tested because they fear the reaction of their family or community if they test positive," he said.
Jacobs also points to the lack of health services for populations particularly affected by the virus – people who inject drugs, men who have sex with men and sex workers.
Ram has commended the Fijian government for taking the crisis seriously. "The government has taken important steps, declaring epidemic status, allocating 10 million Fijian dollars (approximately €3.8m) to combat HIV, and proposing action and strategy plans," she said.
"However, the scale of the increase in cases shows the urgent need to implement evidence-based interventions more quickly and on a larger scale. This includes expanding testing, rapid referral to treatment, comprehensive prevention including harm reduction and condom distribution, as well as increased efforts to reduce stigma and protect access to services."
A regional issue
For Jacobs, while Fiji has declared the epidemic a "national crisis", the same vigilance must be extended to other countries in the region.
"The combination of circumstances that led to this situation in Fiji could also occur in other Pacific nations," he said. "This is an important warning for these countries, which must seize this opportunity to examine their own vulnerabilities."
Ram agrees, noting that: "Injecting drug use and sexual transmission in a context of low condom use and population mobility do not stop at borders."
She called for a strengthening of regional coordination in prevention and surveillance to prevent epidemics from "spreading silently".
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Australia and New Zealand provided financial support to Fiji in 2025 to combat the HIV epidemic. Wellington pledged NZ$4m (€2m), while Canberra contributed A$7.1m (€4.3m).
In November 2025, the Australian government announced a further A$48m (€29m) to provide broader assistance to South Pacific countries in managing rising HIV infection rates.
"I think it's fair to say that this is great," said Ram. "These are very significant contributions. But more will be needed."
This article was adapted from the original version in French by Léo Roussel.
