Fiji is grappling with what is now considered one of the world's fastest-growing HIV epidemics, with health officials declaring a national outbreak and citing an exponential rise in new infections. The crisis is being fueled by a burgeoning methamphetamine problem and the associated high-risk behaviors of "chemsex" and "bluetoothing"—a dangerous practice of sharing blood from a person who has just injected drugs to transmit the high. In the first six months of 2024 alone, Fiji's Ministry of Health and Medical Services recorded 552 new HIV cases, a figure already 33% higher than the entire caseload for 2023.
The situation has become so dire that Prime Minister Sitiveni Rabuka's government has requested assistance from the United Nations to manage the spiraling epidemic. UNAIDS has described the surge as "extremely alarming," noting that new cases are doubling annually, placing Fiji second only to the Philippines for the highest increase in the Asia-Pacific region.
The primary drivers of this health crisis are injecting drug use and specific high-risk practices that have become more common. Health authorities have identified "bluetoothing," where a person injects a drug like methamphetamine, withdraws their blood into the same syringe, and shares it with others, as a major factor in transmission. Dr. Dashika Balak, a senior medical officer, explained that this direct sharing of blood significantly elevates the risk of transmitting not just HIV, but other blood-borne diseases.
This practice, often born from the inability to afford more drugs, is accelerating the spread of the virus at a terrifying rate. The epidemic is disproportionately affecting the nation's youth, with 73% of new infections occurring in people under the age of 39. Data from January to June 2024 shows significant numbers of new cases among young age groups: 50 cases in those 15-19 years old, 137 in the 20-24 age bracket, and 128 among those aged 25-29.
The crisis has prompted the government to launch an HIV Outbreak Response Plan and a longer-term HIV Surge Strategy for 2024-2027 to contain the outbreak and strengthen health systems.
The response from both national and international bodies is intensifying. The Fijian Ministry of Health has declared a national HIV outbreak, a move that enables the mobilization of resources to fast-track interventions. The United Nations Development Programme (UNDP) and other partners have delivered emergency supplies, including thousands of antiretroviral (ARV) drugs and rapid test kits for HIV and other diseases.
Despite these efforts, significant challenges remain. UNAIDS Pacific Adviser Renata Ram noted that Fiji's response is about "15 years behind what is needed," pointing to long delays in test results and a historical decline in funding for prevention programs. The stigma surrounding both drug use and HIV makes many reluctant to seek testing or treatment, leading to late diagnoses and preventable deaths.
In 2024, 126 people died from HIV-related illnesses, including eight children, with many of these deaths attributed to late diagnosis.
- The "Bluetoothing" Phenomenon: A key driver of Fiji's HIV surge is the high-risk practice known as "bluetoothing" or "blasting." It involves one person injecting methamphetamine, drawing their own blood mixed with the drug back into the syringe, and then sharing that blood-filled syringe with others to share the high. This method is particularly common when there is a limited amount of meth available.
- Health officials report this is not just sharing needles but a direct transmission of blood, which dramatically increases the risk of spreading HIV and other infections like Hepatitis B and C.
- Statistical Surge and Demographics: The numbers paint a grim picture. After recording 415 new cases in all of 2023, Fiji registered 552 new cases in just the first half of 2024. A UNAIDS report highlighted a staggering 281% increase in new diagnoses in 2024 compared to the previous year.
- The epidemic is heavily concentrated among younger populations, with individuals under 39 accounting for 73% of new infections. The 20-29 age group is the most affected, representing 51% of cases recorded between January and September 2024.
- Injecting Drug Use as a Primary Cause: While sexual contact was historically the main mode of HIV transmission in Fiji, injecting drug use is now a dominant factor. Of the new cases reported from January to September 2024 with a known transmission route, over 50% were attributed to injecting drug use.
- Authorities have stated that a person who injects drugs and shares needles is 29 times more likely to contract HIV, highlighting the direct link between the nation's methamphetamine crisis and the HIV outbreak.
- Government and International Response: In response to the crisis, Fiji's Minister for Health, Dr. Atonio Lalabalavu, declared a national HIV outbreak in early 2025. The government launched a 90-day HIV Outbreak Response Plan for immediate action and a broader HIV Surge Strategy 2024-2027.
- International partners are providing crucial support; the UNDP has delivered emergency antiretroviral drugs and medical supplies, while Australia has contributed funding to bolster health infrastructure.
- Challenges of Stigma and Underfunding: Years of underfunding and the deterioration of HIV/AIDS services have left Fiji unprepared for this surge. A significant decline in funding for prevention initiatives after 2013 created a gap in awareness and services.
- Furthermore, the social stigma associated with drug use and HIV prevents many from seeking help, leading to late diagnoses. In 2024, only 36% of people living with HIV in Fiji were aware of their status, and just 24% were receiving treatment.
- Regional Implications: As a major hub for business, education, and transport in the Pacific, Fiji's HIV crisis poses a threat to the entire region. UNAIDS Regional Director Eamonn Murphy warned that rising infections in Fiji "put the entire Pacific region at risk," as the virus could spread via returning students and workers to other island nations with potentially less capacity to detect and manage it.
- The crisis is exacerbated by Fiji's role as a transit point for international drug trafficking to markets like Australia and New Zealand.
- Impact on Children and Youth: The epidemic is having a shocking impact on the youngest citizens. Officials have reported seeing children as young as 10 and 12 years old testing positive for HIV due to drug use.
- In 2024, 41 children were diagnosed with HIV, a significant increase from 11 the previous year, with 32 of these cases resulting from mother-to-child transmission. That same year, eight children were among the 126 HIV-related deaths recorded.
