The Pacific island nation of under one million people grapples with one of the world’s fastest-growing HIV epidemics, driven by drug use and sexual transmission, as authorities ramp up testing, treatment and harm reduction.

Fiji has formally declared a national health emergency over a dramatic surge in HIV infections, with health authorities estimating that one in every 60 adults in the Pacific island nation is now living with the virus. The announcement marks a significant escalation from an outbreak declaration made in early 2025, as cases continue to climb at one of the sharpest rates seen globally.

Health Minister Dr Ratu Atonio Lalabalavu made the declaration in a statement, backed by Prime Minister Sitiveni Rabuka and the Cabinet. He said an “outbreak-level response is no longer sufficient” to tackle what has become a full-blown epidemic requiring coordinated, whole-of-government action. The move follows a cabinet decision earlier in September and activates emergency powers under public health legislation last used during the COVID-19 pandemic.

Alarming Rise in New Diagnoses and Prevalence

In 2025 alone, Fiji recorded 2,016 new HIV diagnoses – roughly 16 times the number reported in 2019 and a substantial increase on the previous year. Five years earlier, prevalence stood at about one in 167 adults. Today the figure is one in 60. UNAIDS estimates that approximately 9,100 people were living with HIV in Fiji in 2025. Of these, only 39 per cent knew their status and just 22 per cent were receiving antiretroviral treatment, far below the global average of around 78 per cent.

The crisis is also hitting women and children hard. Roughly one in 50 pregnant women is estimated to be living with HIV. In 2025, 59 babies were born with the virus and 18 died before their first birthday. Health officials have recorded rising HIV-related deaths overall, including among children and teenagers. Two-thirds of new diagnoses last year were among people aged 20 to 34, underscoring the epidemic’s heavy impact on younger adults.

Drivers of the Epidemic: Drugs, Needle Sharing and Sexual Transmission

Experts and officials point to a combination of factors behind the rapid spread. A rise in methamphetamine use and injecting drug practices has played a central role. Among cases with a known mode of transmission, more than half were linked to sexual transmission and over 42 per cent to injecting drug use.

Particularly concerning is the practice known as “bluetoothing” or “hotspotting,” in which people inject the blood of someone already intoxicated to share a cheaper high while using fewer syringes. Limited access to clean needles has compounded the risk. The epidemic, once more concentrated among people who inject drugs, is now spreading more widely across the population of fewer than one million people. Fiji serves as a regional hub for travel, trade and tourism, raising concerns that unchecked transmission could affect other Pacific nations.

Expanding Testing, Treatment and Prevention Measures

In response, the government is scaling up free, voluntary and confidential testing, including rapid tests, and expanding access to treatment and care. Officials stress that every diagnosis must lead to treatment and that people starting antiretroviral therapy need ongoing support to stay on it. Prevention efforts will include wider availability of pre-exposure prophylaxis (PrEP), including long-acting injectable options given twice a year.

A formal needle and syringe programme is also planned. Fiji already has sufficient supplies of needles and syringes; legislative amendments are expected to go before parliament to enable the harm-reduction service to operate legally. The government has emphasised that HIV status is protected by law and that discrimination against people living with HIV is unlawful. Minister Lalabalavu urged people to come forward for testing without fear: “No one should be ashamed, threatened, or excluded because of their HIV status. Stigma drives people away from the very services that can help them.”

Whole-of-Government Response and International Support

A cabinet subcommittee has been established to remove policy and implementation barriers and accelerate action. The declaration is intended to mobilise resources and coordination across government departments and society. International partners including Australia, New Zealand, India, the Global Fund and United Nations agencies are providing support.

UNAIDS Executive Director Winnie Byanyima welcomed the decision, describing Fiji’s situation as “a stark reminder to the world that AIDS is not over.” She noted that the country is experiencing one of the sharpest increases in new HIV infections globally, with new infections rising dramatically since 2010. World Health Organisation data place Fiji as having the second-fastest-growing HIV epidemic in the Asia-Pacific region after Papua New Guinea.

Long Road Ahead to Control the Outbreak

Health officials caution that turning the epidemic around will take years rather than months. Jason Mitchell, who leads the national HIV response taskforce, has said it could take upwards of five years for Fiji to get on top of the crisis. “It’s a long-term programme, it’s not something like COVID that’s turned around in two years. HIV is very different,” he noted.

Without sustained action, experts warn prevalence could climb further. With decisive intervention – expanded testing, treatment adherence, harm reduction and prevention – authorities hope to slow the rise and protect future generations. The declaration of a national emergency signals that Fiji is treating the threat with the urgency it demands, but success will depend on sustained political will, community engagement and the willingness of people to seek testing and care free from stigma.

The coming months will be critical as new programmes are rolled out and legislative changes take effect. For a small island nation whose health system is already under strain, the fight against HIV has become one of the most pressing public health challenges of the decade.