Fiji declares HIV emergency. One in 60 people now have the virus as drug crisis fuels outbreak

(CNN) — The small Pacific nation of Fiji has declared a national HIV emergency as it grapples with surging case numbers, partly driven by a growing methamphetamine problem.

One in every 60 adults in the archipelago of less than a million people are now estimated to have Human Immunodeficiency Virus (HIV) –– bucking a global trend of falling rates of the incurable, but treatable, virus.

A tourism hotspot famed for its friendly culture, white-sand beaches and teeming coral reefs, Fiji first declared an outbreak of the virus in January 2025 and ramped up testing, revealing the scale of the spiraling public health crisis.

Declaring the emergency on Tuesday, Health Minister Dr. Atonio Lalabalavu said the country had 2,060 new diagnoses of HIV in 2025, calling it a sign of the “seriousness of the epidemic and the urgent, coordinated response our country now needs.”

The epidemic has reached the country’s newborns, with a two-month-old baby becoming the youngest identified patient living with both HIV and tuberculosis (TB), Save the Children Fiji said this week. HIV attacks the immune system and makes it easier to contract TB. Last year, 59 babies acquired HIV from their mother, the organization said.

Five years ago, one in 167 Fijians were estimated to be living with HIV. But in recent years, Fiji has seen a surge in intravenous drug use as the islands have emerged as a crucial transit point for narcotics being trafficked from the Americas to lucrative markets in Australia, New Zealand, and parts of Asia.

This, along with persistent sexual transmission spurred by low condom use and stigma, has made the outbreak difficult to tackle.

The alarming statistics do not capture the full scale of the crisis, said Renata Ram, Fiji adviser for the Joint United Nations Programme on HIV/AIDS (UNAIDS).

“What concerns me most is the speed of the epidemic and the number of people who may be living with HIV without knowing it,” Ram told CNN.

Only around 39% of people living with HIV in Fiji know their status, and less than a quarter (22%) are on treatment, Ram said.

When left untreated, the virus can progress to Acquired Immunodeficiency Syndrome (AIDS), making the body highly susceptible to fatal illnesses and cancers.

Fiji reported 117 HIV-related deaths in 2025, up from 25 in 2021, according to national health statistics.

Drug use and unprotected sex drive health crisis

Fiji’s HIV crisis is caused by multiple factors, “but injecting drug use has become a major and rapidly accelerating route of transmission,” Ram said, adding that it is common to share needles.

Massive stockpiles of methamphetamine smuggled onto the islands by cartels have seeped into the local communities, spurring a widespread addiction crisis and straining the local health system.

In 2025, people who inject drugs made up roughly half of new HIV cases in Fiji where a transmission mode was identified, while the other half contracted the virus through sexual transmission, according to national health statistics.

Ram said low condom use, multiple sexual partners, limited testing and stigma are contributing factors.

HIV is spread through the exchange of body fluids from an infected person into the bloodstream of an uninfected person.

One in 50 pregnant women in Fiji are infected with the virus, said Lalabalavu, the health minister. Infected mothers can also pass HIV to their infants during pregnancy, labor and delivery, and breastfeeding.

Fiji’s growing epidemic bucks the trend globally, where enormous progress has been made against HIV.

UNAIDS estimates the number of new HIV infections worldwide has declined by an estimated 42% between 2010 and 2025, Ram said.

“Fiji has experienced an extraordinary increase over essentially the same period,” Ram said.

Fiji’s low rate of people receiving treatment also stands in contrast to the global average, where 78% of people with HIV are accessing treatment.

Stigma is a barrier to treatment

HIV is “not only a health issue,” said Joeli Colati, executive director of Fiji Network Plus, a community organization that supports and advocates for people who are HIV positive.

“It’s also connected to stigma, poverty, transport, confidentiality, fear.”

Colati, who has been living with HIV for 19 years, said there are many reasons why someone may be hesitant to get treatment.

“The reason is not always that somebody does not want treatment,” he said. “It can be fear of being recognized at the HIV clinic.”

Fiji is a deeply religious society, where premarital or casual sex is generally considered taboo.

Colati said there is also a major information gap about HIV in Fiji, with many people not understanding how the virus is transmitted or how effective treatment can be.

In his address Tuesday, Lalabalavu said Fiji will be moving “quickly” to respond to the emergency, expanding testing, treatment and access to pre-exposure prophylaxis (PrEP) –– a preventative medication –– as well as introducing a formal needle and syringe program.

“I ask anyone who may have been exposed to HIV, including through sharing needles or other injecting equipment, or sex without a condom, to come forward for testing. Do not wait until you feel unwell.”

Lalabalavu also encouraged Fijians not to shame, exclude or threaten anyone because of their HIV status, saying “stigma drives people away from the very services that can help them.”

Colati said he knows firsthand what “treatment, support and hope can do.”

“Please don’t let fear make decisions for you,” he said. “Knowing your HIV status gives you the power to do something about it.”

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