Fiji declares emergency as HIV cases surge amid crystal meth crisis

Fiji's government announced a national emergency in September after HIV infections rose twelvefold between 2010 and 2025, with an estimated 9,000 people now living with the virus, or about one in 60 adults. Public health specialist Jason Mitchell, who leads the country's HIV response, told the AIDS 2026 conference that the epidemic is the fastest-growing worldwide, with two-thirds of new cases among 20-34-year-olds.

Health officials attribute the surge largely to a parallel crystal-methamphetamine epidemic. The drug, long present as a transit point, has become more widely used locally since the COVID-19 pandemic, driven by rising unemployment and mental-health stresses. Doctor Sailosi Soqo said lockdowns left many young Fijians, some as young as nine, turning to injectable meth, often sharing needles in a practice known locally as “bluetoothing.”

"You add the existing culture in Fiji of sharing things, plus the limited access to clean injecting equipment, and you get the perfect storm for HIV transmission," Soqo said.

Sharing needles has amplified transmission, with estimates that each infected person may pass the virus to ten others. Sexual transmission also remains significant, accounting for roughly half of new cases in 2025, while condom use is low; a 2021 survey found only 24% of men and 9% of women with multiple partners used a condom last time.

International aid is flowing, including a $48 million package from Australia to expand testing, treatment and prevention. Australian physician Storm Holwill said efforts are under way to ensure every pregnant woman is tested for HIV. However, outreach is hampered by the dispersed island population, limited diagnostic coverage—about 5,676 of an estimated 9,100-12,000 cases are officially recorded—and obstacles to distributing antiretroviral and PrEP medicines.

"We’ve just introduced PrEP about two months back. The uptake has been very slow, and antiretroviral treatment is sitting on shelves," Mitchell said.

Local health leaders are establishing mobile clinics, training peer workers, and planning to distribute sterile needles, but law-enforcement opposition has stalled needle-exchange proposals. New preventive options, such as the injectable PrEP drug lenacapavir and vaginal rings for pregnant women, are expected to arrive later this year.

Officials warn that if current trends continue, Fiji could see 25,000 people living with HIV by 2029, overwhelming an already strained health system.

"Time is not on our side. All our main hospitals are overcrowded and facing staffing shortages," Soqo warned.