Fiji declares HIV a national crisis as meth-fueled outbreak outpaces treatment

Fiji's government has declared the country's HIV epidemic a national crisis, an escalation that clears the way for emergency legislation and funding after new infections climbed sharply for a third consecutive year. The declaration, approved by Cabinet on September 15 at the recommendation of Health Minister Dr. Atonio Lalabalavu and backed by Prime Minister Sitiveni Rabuka, marks the most serious public-health designation Fiji has issued since the coronavirus pandemic.

The move follows more than a year of warnings from Fiji's own health ministry and from international agencies that a surge in methamphetamine injecting was driving one of the fastest-growing HIV epidemics in the world. On September 17, Lalabalavu told reporters in Suva that the government would not impose mandatory HIV testing, saying the measure is "not under the HIV Act," and would instead rely on expanded voluntary testing, treatment and prevention programs, according to reporting by the Fiji Sun.

The scale of the outbreak

Fiji's government now estimates that one in every 60 adults in the country is living with HIV, up from roughly one in 167 five years ago. Antenatal screening shows HIV prevalence of about 2 percent among pregnant women, meaning roughly one in every 50 expectant mothers tests positive. According to a press release from UNAIDS, new HIV infections in Fiji rose twelvefold between 2010 and 2025, with an estimated 9,100 people now living with the virus. Only 39 percent of that population knows its status, and just 22 percent are on antiretroviral treatment — far below the global treatment-access average of roughly 78 percent.

Fiji's Ministry of Health recorded 2,016 new HIV diagnoses in 2025, a 27 percent increase over the 1,583 diagnoses logged in 2024, itself already a sharp jump from prior years. HIV-related deaths climbed to 117 in 2025, up from 25 in 2021. Of new cases in 2025 where a transmission route could be identified, UNAIDS says slightly more than half involved sexual contact and more than 42 percent were linked to injecting drug use, chiefly of methamphetamine.

A drug crisis meets a strained health system

Fiji's government first flagged the emergency in January 2025, declaring a formal HIV "outbreak" after new cases nearly tripled the prior year's pace, and describing the epidemic as the second-fastest growing in the Asia-Pacific region. A rapid assessment commissioned by the World Health Organization and the UN Development Programme, carried out with Australia's Kirby Institute through interviews with 56 people who inject drugs and 50 stakeholders, found that unsafe injecting — driven by a scarcity of sterile needles and syringes — was the epidemic's central driver. The assessment, published by the World Health Organization, found that nearly half of new treatment enrollments in 2024 were among people who inject drugs, and it urged the "urgent introduction" of needle and syringe programs, which Fiji has never operated nationally.

The underlying driver, officials and researchers say, is geography. Fiji has become a transshipment point for methamphetamine trafficked from the Americas toward lucrative markets in Australia, New Zealand and parts of Asia, and stockpiles intended for export have increasingly been diverted into local use, fueling an injecting-drug crisis that outpaced the health system's harm-reduction capacity. Fiji's HIV Surge Strategy, adopted for 2024-2027, set targets modeled on the UN's "95-95-95" goals — 95 percent of people with HIV diagnosed, 95 percent of those on treatment, and 95 percent of those virally suppressed — but the latest data show the country falling well short on the first two benchmarks.

Who is being hit hardest

The burden is concentrated among people who inject drugs, who account for roughly half of new infections nationally, and reporting from the Pacific Islands News Association notes that young men now make up the largest share of cases attributed to male-to-male transmission. Health officials have also flagged a near-doubling in pediatric HIV cases and rising infections among pregnant women, raising the risk of mother-to-child transmission in a country where antenatal HIV testing has not been universal. Geographically, Fiji's Central Division — home to Suva and the country's largest population center — has recorded the largest share of new cases, though officials say infections are now appearing across all four divisions.

• One in 60 Fijian adults is now estimated to be living with HIV, versus one in 167 five years ago
• 2,016 new diagnoses were recorded in 2025, a 27 percent rise over 2024
• Only 39 percent of people with HIV in Fiji know their status, and 22 percent are on treatment
• People who inject drugs and young men account for a growing share of new infections

UNAIDS has also warned the crisis carries regional stakes. Eamonn Murphy, the agency's Asia-Pacific regional director, has previously said that "rising new infections in Fiji put the entire Pacific region at risk," given travel and migration links among island states with far smaller health systems and even less capacity to absorb a comparable outbreak.

Reaction and what happens next

UNAIDS welcomed the national-crisis declaration as a turning point. "Fiji has recognized the urgency of the moment and is stepping up its response," Executive Director Winnie Byanyima said in the agency's statement. Murphy added that "the national crisis declaration is a call for action, not fear," stressing that HIV is not transmitted through everyday contact — a message aimed at heading off stigma toward people diagnosed with the virus. A separate statement carried by the United Nations in the Pacific echoed those calls for a rights-based, non-discriminatory response.

"Discrimination and stigma will only serve to make our current situation worse," Health Minister Atonio Lalabalavu has said of the outbreak.

Lalabalavu's ministry has committed FJ$10 million (about US$4.4 million) to the response and formed a five-member Cabinet subcommittee tasked with clearing bureaucratic delays that have slowed implementation of earlier plans. Fiji intends to introduce, for the first time nationally, a needle and syringe program, which will require legislative amendments to go before Parliament; officials also plan to widen access to pre-exposure prophylaxis, including longer-acting injectable versions, and to expand routine testing and treatment capacity, according to reporting by Fijivillage. Lalabalavu has ruled out compelling anyone to be tested, saying the government will instead pursue what he called "a holistic view" that combines expanded voluntary testing with treatment for related illnesses such as tuberculosis, which often accompanies untreated HIV.

The response is also drawing on outside support: UNAIDS says its Joint Programme is providing policy advice while regional and international partners, including Australia's Indo-Pacific HIV Partnership, contribute funding, medical supplies and technical expertise. Whether the national-crisis declaration translates into faster results will depend largely on how quickly Fiji's Parliament can pass the needle-and-syringe legislation and how effectively the new Cabinet subcommittee can push funded programs past the administrative bottlenecks that officials acknowledge slowed the response through 2025.