Fiji's HIV Crisis: Meth Use and Stigma Fuel World's Fastest-Growing Epidemic
The escalating use of methamphetamine, unsafe injecting practices, and critically low health awareness are among the primary factors driving the rapid spread of HIV in Fiji. Vulnerable young people, partners of drug users, and victims of sexual violence are also among those afflicted in what has become the world's fastest-growing HIV epidemic, occurring amidst a global decline in international aid.
A Mother's Heartbreak and a Preventable Tragedy
When her baby's heart stopped, Clare* blamed herself. Rushing her month-old daughter, Andi*, to a hospital in Fiji for the second time in two days, she fixated on the infant's tiny chest, willing it to breathe. Doctors performed CPR multiple times, inserting a drain into the baby's chest to remove fluid from her lungs. "She was really, really sick and they didn't know what was going on," Clare recalls. Then, doctors requested an HIV test for the baby.
Clare was confused, having already tested negative herself. The devastating truth emerged: Andi was HIV positive. So were Clare and her husband. Clare had contracted the virus during late pregnancy or breastfeeding and passed it to her daughter, who will now live with a chronic disease. "I thought it was the end of the world," says Clare, in her early twenties. Her husband, an injecting drug user, denied responsibility. Clare's young family is one of thousands caught in Fiji's escalating HIV crisis.
An Epidemic Exploding Among the Young and Addicted
New HIV cases in Fiji more than tripled between 2023 and 2024. In the first six months of 2025 alone, over 1,200 people were diagnosed. The United Nations attributes this rapid spread to Fiji's role as a drug-running hub, escalating local methamphetamine use, unsafe injecting practices, and a lack of access to clean needles. Compounding the crisis are low health awareness, deep cultural stigma, and inadequate testing and treatment infrastructure.
This has become a disease predominantly affecting the young and addicted. Approximately half of those contracting HIV are believed to have done so through sharing contaminated needles or drug preparation equipment. Alarmingly, infections are now growing among the most vulnerable: babies born with—and dying from—HIV/AIDS complications.
Health authorities report that one baby per week is diagnosed with HIV via mother-to-child transmission. Intensive care units are seeing an influx of infants requiring life support. Dr. Jason Mitchell, head of Fiji's HIV epidemic response, states that one child under five dies every month as doctors struggle to diagnose them. "It is the figure that I feel most pained by, because it is preventable," he says. "It is inexcusable to have any more children born with HIV."
Cultural Stigma and a Lack of Basic Knowledge
Fiji, an archipelago of over 300 islands with a population of about 930,000, is a deeply Christian nation where religion coexists with traditional beliefs. Distrust of Western medicine remains common among the iTaukei, or Indigenous Fijians, who constitute roughly half the population and about 90% of those diagnosed with HIV.
"If you're living with HIV you're sinful, you're going to hell, period," says Christopher Lutukivuya, a 38-year-old HIV activist living with the condition since 2013. He has witnessed friends expelled from family homes or forced to live in basements, and others who deny their illness or take their own lives rather than admit to having HIV. He drives people to get tested and picks up medication for those afraid to be seen at clinics.
Dr. Mark Jacobs, the World Health Organization representative for the South Pacific, notes that basic HIV knowledge is severely lacking. "The sorts of things that were issues in Australia in the 1980s, we're now seeing in the Pacific," he says, referencing dangers of needle sharing, lack of safe needle programs, and low acceptance of condom use. In villages, some leaders spoken to did not know HIV could be passed from mother to child or that it was treatable.
Children on the Streets: Addiction and Survival
On the streets of Suva, Fiji's capital, children survive through mugging or acting as drug pushers. Many inject methamphetamine the first time they encounter it, as it's quicker, cheaper, and allows more to get high simultaneously. Dr. Dashika Balak observes, "Most of the children that we speak with prefer staying on the streets because this is where they get the drugs."
Transnational criminal syndicates target Fiji both as a transit point for drugs to New Zealand and Australia and as a growing local market. At the Kauwai Youth Restoration Home, social workers rehabilitate young people. Isac*, 17, who ran from an abusive uncle, and Nemaia*, 15, who fell in with the wrong crowd, both became addicted to meth and contracted HIV through needle sharing.
Isac, now back in school and aspiring to be an accountant, recalls, "I was fit. And after that, I became slim. I lost all my weight." Nemaia, who spent two years stealing on the streets, was brought to the hostel after a video of him shooting up another boy went viral. Both now receive treatment and advocate for change.
Innocence Lost and Glimmers of Hope
Dr. Kesaia Tuidraki, chief medical officer at Medical Services Pacific, notes that telling a child they have HIV is a learned skill, as most don't understand even as their parents cry beside them. On average, one person with HIV will spread it to ten others, mostly through shared needles, unsafe sex, or rape. Dr. Tuidraki routinely provides HIV prophylaxis to sexual assault victims, most of whom are girls under 18. "It's hard to stomach when the people who are impacted by this are completely innocent," she says.
Despite the challenges, there are signs of progress. Her organization has ramped up testing with mobile clinics in Suva and remote villages. If HIV is detected early in pregnancy, antiretroviral medications can suppress the virus, lowering or preventing mother-to-child transmission.
Renata Ram, a Pacific adviser for UNAids, says the agency is working with the Fijian government to make Pre-exposure Prophylaxis (PrEP) available within six months via tablets, injectables, and a vaginal ring women can wear discreetly. "Most women being picked up right now are not injecting drug users or sex workers. The majority are married women who get HIV within their marriage and do not have much say in terms of their protection," Ram explains. The aim is to "reduce harm while we are still working on the human rights aspect of things."
A Looming Threat and a Call for Action
Authorities are expected to upgrade the pandemic threat level to that of a generalized epidemic in coming months. While the Fijian government allocated $10 million last year to the response, matched by millions from Australia and New Zealand, Dr. Mitchell emphasizes that more pressure is needed. "It cannot just be business as usual," he states.
Up to 8,900 people are living with HIV in Fiji, according to UNAids data, though authorities admit this may not reflect the full picture. The 126 official deaths recorded in 2024 are also considered unrepresentative, as deaths linked to HIV/AIDS are often not recorded to avoid family shame.
In villages, leaders like Rusiate Togotogorua, a headteacher, express grave concern. "I don't want one of my family members to be affected because that virus kills a generation," he says. "Not just one, but a generation. It will come."
Safe Havens and Messages of Hope
On the outskirts of Nadi, the Daulomani Safe House, founded by trans woman and former sex worker Edwina Biyau, caters to women, trans women, and children surviving drugs, HIV, and violence. Biyau stresses that HIV affects everyone, not just specific groups. "You can say that you're innocent. You're not going out. You're just going to church. But how about your husband? How about your uncle? How about your brother?" she says. "That's why so many people are dying. Because it's too late."
Biyau presents newcomers with Josy Ralulu, a sex worker who tested positive for HIV in 2022. "At first, I was shocked," Ralulu says. "I thought I was dead. And then the doctor told me, calm down. There's medication for it that's gonna make you live."
For Biyau, the path forward is paved with love and hope. "You got infected with HIV. But that's not the end of the world. You know, you can write a new chapter. You can have a new story to tell. This is what happened, and this is hope. You still can live."
*Names have been changed to protect identities.
