Crystal Meth Driving Record HIV Surge in Fiji Amid National Emergency

The island nation of Fiji has declared a national emergency in response to a rapidly escalating HIV epidemic, a crisis health officials attribute primarily to widespread crystal meth addiction. With infection rates rising twelve-fold between 2010 and 2025, estimates now indicate that approximately 9,000 people are living with the virus, equating to one in every 60 adults.

Jason Mitchell, who leads Fiji’s public health response to HIV, described the outbreak at the AIDS 2026 conference in Rio de Janeiro as the fastest-growing HIV epidemic globally. He highlighted that two-thirds of new infections occur in individuals aged 20 to 34. “Our young, active, productive population is currently being infected with HIV, and unless we find solutions quickly, this will continue to get worse,” Mitchell said.

While Fiji has long served as a transit hub for narcotics traveling from South America to Australia and New Zealand, the post-pandemic era triggered a domestic surge in methamphetamine use. Sailosi Soqo, a doctor on the national HIV response team, explained that the pandemic’s economic fallout and lockdowns pushed many into unemployment and poor mental health. Simultaneously, stricter border security in destination countries trapped more drugs within Fiji, creating a previously non-existent local market.

The shift from smoking to injecting meth has proven particularly lethal. Dashika Balak, who oversees national HIV treatment and care, noted that needle-sharing is a major transmission vector. This includes “bluetoothing” or “hotspotting,” a practice where one person injects the drug and then others inject their residual blood. While often driven by poverty, experts suggest the practice is also reinforced by Fiji’s communal culture around sharing drinks like kava, as well as a scarcity of clean needles due to law enforcement crackdowns.

Sexual transmission remains another significant factor, accounting for roughly half of new cases in 2025. Condom usage is alarmingly low; a 2021 survey revealed that only 24% of men and 9% of women with multiple partners used protection during their last sexual encounter. Mark Shaheel Lal, founder of Living Positive Fiji, contracted HIV through unprotected sex in 2024. “You let your guard down once, and boom, it happens,” he said.

The crisis has drawn international support, including a $48 million funding package from Australia announced in August. A primary goal is ensuring all pregnant women receive HIV testing to prevent vertical transmission, which affected 59 babies in 2025. However, access to care remains a hurdle. Of the estimated 9,100 to 12,000 people living with HIV, only 5,676 have been officially diagnosed, and many lack consistent contact information for treatment follow-up.

Geographic isolation exacerbates the issue. Lal pointed out that PrEP and antiretrovirals are only available at three clinical centers in Suva, Lautoka, and Labasa. For a population scattered across more than 100 islands, these journeys are prohibitive, leading some to rely on prayer instead of medical intervention.

To improve reach, Fiji is establishing HIV response teams in 21 locations and deploying peer support workers, including former meth users who are HIV-positive. Despite these efforts, legal barriers persist. Soqo revealed that prosecutors have threatened to arrest medical staff who distribute sterile needles, leaving him with a warehouse of unused equipment. “If you hand these out, we’ll arrest you, and we’ll charge you for aiding and abetting,” Soqo recounted.

Looking ahead, Mitchell expressed optimism about new preventive tools, including lenacapavir, an injectable PrEP requiring only two doses per year, and vaginal rings for women. These innovations are critical, as projections suggest the number of people with HIV could reach 25,000 by 2029 if the current trajectory continues. Soqo warned that Fiji’s already strained healthcare system, facing chronic staffing shortages and overcrowding, would collapse under such a load. “Time is not on our side,” he said. “There is an urgent need for more action now.”