Mark Shaheel Lal is the founding father of Dwelling Optimistic Fiji and a reconciliation officer for the Fiji Fact and Reconciliation Fee. He says: “The vast majority of my buddies, they acquired HIV by way of crystal meth.” He was photographed on the AIDS convention in Rio de Janeiro, Brazil, in July.
Ian Cheibub for NPR
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Ian Cheibub for NPR
Finest referred to as a tropical paradise and honeymoon vacation spot, the island nation of Fiji now has the unlucky distinction of going through two intertwined epidemics: HIV and dependancy to crystal meth.
With HIV circumstances rising by 12-fold between 2010 and 2025, in mid-September, Fiji’s authorities declared a nationwide emergency. Estimates are that there are upward of 9,000 circumstances; the nation’s well being minister has introduced that 1 in 60 adults at the moment are dwelling with HIV.
On the July AIDS 2026 convention in Rio, Jason Mitchell, a public well being specialist main Fiji’s HIV response, described it because the fastest-growing HIV epidemic on the planet, noting that two-thirds of circumstances are in these ages 20-34. “Our younger, lively, productive inhabitants is at present being contaminated with HIV, and except we discover options rapidly, this may proceed to worsen,” he says.
A key trigger is one other parallel epidemic — the rampant use of crystal meth among the many nation’s youth, who typically inject it. That has led to transmission by way of shared needles.
“Two of my finest buddies handed away,” says Mark Lal, a 25-year-old HIV activist from Fiji’s capital of Suva. “The vast majority of my buddies, they acquired HIV by way of crystal meth.”
The meth issue
Crystal meth has lengthy been accessible to some extent inside Fiji — the islands are a identified transit hub for the drug between South America and the eventual locations of Australia and New Zealand. However since COVID, meth use has soared, one thing Fiji’s HIV consultants attribute to the deadly mixture of rising unemployment and ever extra accessible medication.
“COVID was a troublesome time for Fijians,” says Sailosi Soqo, a physician engaged on the nationwide HIV response workforce. “Most misplaced their jobs, acquired much less hours or have been caught at residence. On the identical time, we suspect that the journey restrictions, together with elevated border safety, decreased the motion of narcotics onto their goal international locations. Medicine that might in any other case have moved on stayed in Fiji, seeding this home market which did not actually exist earlier than.”
Soqo means that spiraling unemployment, mixed with worsening psychological well being because of the impacts of lockdown, led to extra younger Fijians turning to meth, even preteens.
“The communities I work with report youngsters as younger as 9 utilizing injectable medication,” he says.
In keeping with Dashika Balak, a physician who leads Fiji’s nationwide HIV remedy, care and help efforts, the chance of HIV transmission has additionally been exacerbated by a nationwide shift from smoking meth to injecting it. This consists of the so-called “bluetoothing” or “hotspotting” apply the place one particular person injects the drug after which one other particular person injects their blood.
Bluetoothing is understood to happen in settings of maximum poverty as a less expensive means of getting excessive. However Mitchell believes that its recognition in Fiji is partially as a result of sharing all method of issues is part of nationwide tradition — each alcohol and the ceremonial drink kava are consumed by way of a communal glass or bowl — and partially because of a shortage of needles. Soqo says that regulation enforcement in Fiji has cracked down on needle availability in an try and curb meth use, one thing that he believes has inadvertently inspired bluetoothing.
Sadly, bluetoothing has fueled the unfold of HIV. Studies counsel that on common, one contaminated particular person in Fiji will move the virus on to 10 others. “You add the present tradition in Fiji of sharing issues, plus the restricted entry to wash injecting gear, and also you get the right storm for HIV transmission,” says Soqo.
Fiji’s HIV epidemic can be spreading in different methods, together with dangerous sexual practices. “What we do know is that sexual activity, as a transmission route, made up roughly 50% of the brand new HIV circumstances for 2025,” says Soqo.
Balak says that low condom use is encouraging the unfold of HIV. A 2021 survey discovered that amongst 15- to 49-year-olds with a number of sexual companions up to now yr, solely 24% of males and 9% of girls used a condom the final time that they had intercourse. Lal can attest to this — having contracted HIV himself in the summertime of 2024 by way of unprotected intercourse with a male companion. “You let your guard down as soon as, and increase, it occurs,” he says.
Stopping a everlasting epidemic
The surge in circumstances has led to an inflow of overseas support to help new HIV testing, prevention and remedy packages. Involved about rising charges of infections and the potential for the epidemic to unfold extra broadly by way of the Pacific, the Australian authorities introduced a brand new $48 million funding package deal in August. In keeping with a press release to NPR, the federal government is dedicated to supporting Fiji’s HIV response to stop new infections, enhance early prognosis and broaden entry to remedy.
One of many first priorities for Australian organizations working with Fiji is to make HIV testing accessible in any respect antenatal clinics. In 2025, 59 infants have been born with HIV.
“We’re attempting to get a dependable rollout of those exams so that each single pregnant girl wherever within the nation shall be examined for HIV,” says Storm Holwill, a public well being doctor working at Melbourne’s Peter Doherty Institute for An infection and Immunity.
Anybody who’s HIV optimistic would then be positioned on viral-suppressing medicines referred to as antiretrovirals to restrict the probabilities of HIV being handed on in utero.
Blocking new infections on a wider scale is much tougher. Meth use is most prevalent in a few of Fiji’s poorest and most weak populations, lots of whom don’t have any fastened tackle. This makes it troublesome for medical professionals to check and prescribe therapies.
Balak explains that whereas wherever between 9,100 and 12,000 folks in Fiji are thought to have HIV, solely 5,676 of those circumstances have been formally recognized. Even fewer are frequently taking antiretrovirals to maintain their situation underneath management.
“Some cease remedy, and a few can’t be reached as a result of their contact particulars are incomplete,” she says.
Which means that whereas Australia’s support is offering Fiji with plentiful entry to medicines similar to PrEP drugs to dam HIV infections, getting these medication to the appropriate folks is just not easy.
Dr. Jason Mitchell is the top of Fiji’s Nationwide HIV Outbreak and Cluster Response Taskforce.
Ian Cheibub for NPR
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Ian Cheibub for NPR
“We have simply launched PrEP about two months again,” says Mitchell. “The uptake has been very sluggish, whereas on the identical time, antiretroviral remedy can be freely accessible, but it surely’s at present sitting on cabinets.”
Lal argues that one of many largest issues is a lack of information. He says many individuals in Fiji have by no means heard of those medicines. Even for individuals who have, acquiring them requires a prolonged journey to one among three devoted scientific facilities, both within the cities of Suva and Lautoka or the city of Labasa.
With Fiji’s inhabitants unfold throughout greater than 100 islands, Lal says that such a journey doubtless deters many individuals from searching for care. “In the event that they know the medicines are far-off, they will not even need to entry them,” he says. “In a rustic like ours the place faith is large, folks would — moderately than go — pray and consider that God will heal them.”
Cell clinics and clear needles
To enhance entry to PrEP and antiretrovirals, Balak and her colleagues have began creating devoted HIV response groups in 21 areas throughout the nation. “They may quickly be capable to order their very own antiretrovirals [and] dispense and totally handle their sufferers on their very own,” she says.
To trace down extra folks dwelling with HIV, the workforce can be recruiting and coaching peer help employees — together with some current meth customers who’re HIV optimistic. Balak says she hopes that this may very well be a approach to join extra of the folks at most threat of contracting HIV with medical groups.
Methamphetamine use stays a tense concern, and a number of the proposed schemes to handle the unfold of HIV have clashed with regulation enforcement.
To interrupt the chains of infections stemming from contaminated needles, Soqo has proposed supplying hundreds of sterile needles and syringes to communities of methamphetamine customers. Nonetheless, Soqo says the federal government is obstructing the plan. “The director prosecutor has informed us, ‘If you happen to hand these out, we’ll arrest you, and we’ll cost you for aiding and abetting,'” he says. “Because of this, I now have a warehouse filled with needles and syringes, simply amassing mud.” Fiji’s authorities didn’t reply to a request for remark from NPR.
Nonetheless, there may be extra optimism that different approaches may make a major distinction. Fiji is about to obtain provides of the drug lenacapavir, an injectable type of PrEP that gives these susceptible to an infection because of sexual conduct or drug use close to 100% safety from HIV. As a result of this new preventive drug solely must be administered twice yearly, Mitchell believes will probably be simpler to persuade folks to make use of it in contrast with day by day drugs.
To forestall ladies from contracting HIV from their companions whereas pregnant, antenatal clinics hope to begin providing vaginal rings, which slowly launch a protecting antiretroviral drug over the course of a month.
Such improvements are badly wanted. Projections counsel that if the epidemic continues at its present tempo, 25,000 folks in Fiji shall be dwelling with HIV by 2029, figures that Soqo says would push Fiji’s fragile well being system to the brink of collapse.
“Time is just not on our aspect,” says Soqo. “With the present numbers, we’re already struggling. All our major hospitals are overcrowded and have continual points with staffing shortages. Our tuberculosis hospitals and first healthcare services are telling us they’re seeing a rise in superior HIV circumstances and are overwhelmed. Think about what issues shall be like in three years’ time. There may be an pressing want for extra motion now.”
David Cox is a contract well being journalist who has written for publications world wide, together with NPR, The New York Instances, Wired and The Guardian. He has a Ph.D. in neuroscience.
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