A Crisis Without Borders - Fiji's Growing HIV Epidemic and the Pacific’s Shared Responsibility
By Genevieve Phillips
Fiji now has the fastest-growing HIV epidemic in the world. The crisis is now being felt throughout the Pacific as this regional emergency demands coordinated action from Pacific Nations and Australia.
The Numbers
The formal HIV outbreak was declared by the Fijian Government in January 2025, reflecting the scale of the unfolding outbreak in the Pacific. Fiji recorded 2,003 new HIV diagnoses in 2025, which has increased from 1,583 in the previous year. Now, the national diagnosis rate has risen from 13 per 100,000 people in 2019 to 266 per 100,000 in 2025, illustrating a 17-fold increase over six years.
Up to 8,900 Fijians are now living with HIV, fast approaching one per cent of the population, which is 930,000. The epidemic is accelerating and now spreading far beyond the original outbreak groups and into the wider community.
This issue is now reaching the youngest and most vulnerable at an alarming rate. At least one baby died from HIV every month in 2025, and an estimated 59 children were born with the virus last year. In the Suva Colonial War Memorial Hospital, antenatal HIV has risen to 3.7 per cent, demonstrating the scale of what is now a grave public health emergency in the country.
The Issue
The epidemic’s primary source is methamphetamine-fuelled drug use, delivered by injection. Fiji has become a major player in Pacific drug trafficking routes, which connect South America to Australia and New Zealand, driving transnational criminal syndicates to turn Fiji into a transit hub, leaving widespread methamphetamine dependence in their tracks. A rapid assessment conducted by the Kirby Institute at UNSW, commissioned by the World Health Organisation (WHO) and the United Nations Development Programme (UNDP), found that every person interviewed had, at some point, reused another person’s needle, as no needle and syringe programme (NSP) currently exists at scale in Fiji.
Stigma also plays a role in every dimension of the crisis. Although many Fijians have been reluctant to seek testing or treatment, this attitude is slowly changing, with clinics now offering free testing to the general population and young people through university programs. A 2021 survey found that fewer than a third of 15 to 24-year-olds had comprehensive HIV knowledge, and that as of 2024, only 36 per cent of people living with HIV in Fiji were aware of their status, and just 24 per cent actually received treatment. The majority of women who are now testing positive are married women with no injecting drug history, which is a sign that the epidemic is now firmly within the general population.
Fiji’s Strategy
Fiji’s National HIV Surge Strategy (2024-2027) is the framework for reversing the epidemic. It aligns with the United Nations 95-95-95 benchmarks, which involve 95 per cent rates of testing, treatment and viral suppression. The framework also includes an accompanying 90-day Outbreak Response Plan, designed to fast-track harm reduction, condom distribution, and pre-exposure prophylaxis.
In February 2026, a national workshop was held in Suva, convening government officials, clinicians, police, and community members to design a locally appropriate needle and syringe programme guided by the WHO. Implementation has been obstructed, however, by funding shortfalls, a strained workforce stretched across multiple islands, and global health funding cuts of 30-40 per cent in 2025, driven by the United States' withdrawal from the WHO and from HIV programme funding.
A Growing Pacific Problem
As Fiji is a regional hub for labour, education and business, it also exhibits significant outward migration, particularly to Australia and New Zealand, through mobility schemes such as the Pacific Australia Labour Mobility (PALM) scheme, which raises the risk of regional spillover. Fiji also receives students and workers from neighbouring Pacific islands, meaning the epidemic in Suva is unlikely to remain confined there.
Australia has taken initial steps through the Indo-Pacific HIV Partnerships with UNAIDS to support prevention scale-up in Fiji. These efforts must be significantly expanded in their scope and funding, and recognised internationally, so that this epidemic is no longer a Fijian problem alone.
What Must Happen Now
There are three main priorities for the Pacific and its neighbours. First, Australia and New Zealand must urgently increase funding for harm-reduction infrastructure in Fiji, particularly for community health workers, mobile testing clinics, and needle-and-syringe programmes. Other countries have shown that these interventions work. Secondly, the Pacific Island Forum must treat HIV as a regional security issue. Labour mobility programmes should include mandatory, designated HIV testing and treatment, thereby linking health services to cross-border travel. Finally, Fiji’s response can continue to centre youth voices and work with community-led organisations. Peer education programmes facilitated by people with lived experiences of injecting drug use have already shown results in Suva.
The Pacific has faced shared crises before and responded with collective resolve; this moment demands nothing less.
Genevieve Phillips is a Bachelor of Law/Arts (History) student and 2025 New Colombo Plan Scholar currently on exchange in Fiji. She focuses on international environmental law, ocean governance, and Australia–Pacific relations. She is passionate about elevating Pacific perspectives, especially on climate mobility and maritime governance, by writing about issues affecting the region that may not be mainstream knowledge for young people, drawing on her lived experience to inform her article topics.
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