Fiji declares HIV emergency as drug crisis fuels outbreak to 1 in 60 adults

Fiji, a Pacific island nation of fewer than a million people known for its beaches and tourism, has declared a national HIV emergency. The announcement came Tuesday from Health Minister Dr. Atonio Lalabalavu, who framed it as a response to what he called the "seriousness of the epidemic and the urgent, coordinated response our country now needs." The numbers behind that declaration are stark: one in every 60 adults in Fiji now carries HIV, a prevalence rate that defies the global trend of declining infections.

Five years ago, the ratio was one in 167. The acceleration has been driven by two converging crises. The first is methamphetamine. Fiji has become a crucial transit point for drugs trafficked from the Americas to markets in Australia, New Zealand, and Asia. Massive stockpiles have seeped into local communities, spurring addiction and, critically, needle-sharing among people who inject drugs. In 2025, roughly half of all new HIV cases where transmission mode was identified came through intravenous drug use. The other half came through sexual transmission, fueled by low condom use, multiple partners, and the stigma that keeps people from seeking protection or treatment.

The scale of the outbreak became visible only after Fiji declared an initial outbreak in January 2025 and ramped up testing. That year brought 2,016 new diagnoses. The human toll has accelerated sharply: 117 people died from HIV-related causes in 2025, compared to 25 in 2021. The virus has reached the youngest and most vulnerable. Save the Children Fiji reported this week that a two-month-old baby is now the youngest identified patient living with both HIV and tuberculosis. Last year, 59 infants acquired HIV from their mothers during pregnancy, labor, delivery, or breastfeeding. One in 50 pregnant women in Fiji carry the virus.

Yet the official numbers capture only part of the crisis. Renata Ram, Fiji adviser for the Joint United Nations Programme on HIV/AIDS, told CNN that what troubles her most is "the speed of the epidemic and the number of people who may be living with HIV without knowing it." Only about 39 percent of people living with HIV in Fiji know their status. Of those, fewer than a quarter—22 percent—are on treatment. By contrast, the global average for treatment access is 78 percent. When HIV goes untreated, it progresses to AIDS, leaving the body vulnerable to fatal illnesses and cancers.

Barriers to treatment run deep. Fiji is a deeply religious society where premarital and casual sex are considered taboo. Joeli Colati, executive director of Fiji Network Plus, an organization supporting people with HIV, has lived with the virus for 19 years. He described the obstacles plainly: "It's also connected to stigma, poverty, transport, confidentiality, fear." Many people avoid HIV clinics not because they refuse treatment but because they fear being recognized. There is also a widespread information gap—many Fijians do not understand how the virus is transmitted or how effective treatment can be. Colati said the fear is real enough to override the desire for help.

Health Minister Lalabalavu announced a response plan: rapid expansion of testing, treatment access, and pre-exposure prophylaxis (PrEP), a preventative medication. The government will also introduce a formal needle and syringe program. He urged anyone exposed to HIV through needle-sharing or unprotected sex to come forward for testing. He also called on Fijians to stop shaming or excluding people based on HIV status, saying "stigma drives people away from the very services that can help them." Colati echoed that message: "Knowing your HIV status gives you the power to do something about it." The question now is whether Fiji's health system can move fast enough to reverse a trend that has already outpaced the world's progress against the virus.