OhOn a recent Friday evening, Dr. Kesaia Tuidraki’s medical team parked their mobile clinic outside McDonald’s in downtown Suva, Fiji, and grabbed every child they could to get tested for HIV. Of the 97 people screened, mostly teenagers – some going to get a hamburger, others to buy drugs – one in six tested positive.
“Children are suffering, children are dying, and if that doesn’t move you, I don’t know what will,” Tuidraki, national director of Pacific Medical Services, told the Guardian.
Fijian authorities this month declared a national health emergency to deal with rising HIV cases, with around one in 60 adults now living with the virus. This comes as new infections rise, with 2,016 new cases diagnosed in 2025, an increase of 27% in one year and a 12-fold increase since 2010, according to UNAIDS. In a close-knit island nation of around 930,000 people, an estimated 9,100 people are now living with the virus.
But only a fraction of them are being tested and accessing treatment, prompting the government to step up its announcement about the pandemic – first made in February 2025 – and mobilize urgent measures to prevent its spread. Dr Jason Mitchell, head of Fiji’s HIV epidemic response, said it would take between five and 10 years to bring the virus under control and in the meantime he expected the numbers to rise.
Critics say measures to stem the spread of a disease that is driven primarily by cases among young people, with new diagnoses more common among those aged 15 to 34, have been too slow. The crisis is complex and inextricably linked to the drug epidemic: more than 42% of new cases in 2025 were due to the sharing of contaminated needles or equipment.
Health advocates and social workers say elementary school-age children are among those who self-inject and their friends use the same contaminated needle, an issue raised by advocates as early as 2019.
“I know these young boys, they ask me for syringes,” Rochelle*, an injecting drug user who lives with HIV, tells the Guardian. “Every time I have some, I distribute them. Someone has to give them, they already have access to the medicines.”
Rochelle, 38, says she tries to tell boys not to share. Sometimes children listen – but not always.
Under current law, the distribution of needles is technically considered aiding and abetting drug use. Some politicians and health professionals fear that providing needles encourages drug use – despite evidence from UNAIDS that this is not the case – and advocates are urging the government to let them distribute thousands of needles and syringes that remain untouched in a Suva warehouse.
“It’s really sad, honestly. We can’t wait any longer, there are already boxes and boxes here,” says Tuidraki.
Mitchell says he expects a change to the HIV law to be passed in the next two weeks, allowing public health workers to distribute syringes. He adds that the government was “cautious” in announcing the state of emergency that his unit had been calling for since June.
Response officials say the increased powers stemming from the emergency declaration will help curb the rapid spread of HIV, including among vulnerable populations like mothers and babies, at an estimated additional cost of FJD$23 million ($10.2 million) per year.
“The immediate crisis right now is the spread of HIV, which is why the needle and syringe program is essential,” said the regional director of UNAIDS, the United Nations agency that fights HIV and AIDS, Eamonn Murphy.
“People are afraid”
The epidemic is complex but strongly linked to methamphetamine use. Fiji is a Pacific drug trafficking hub for methamphetamine destined for the Australian and New Zealand markets, but its use intensified during Covid when borders were closed and methamphetamine began to circulate into the country.
Although Fijians want the crisis to be resolved, there have also been backlashes. According to UNAIDS, only 39% of people living with HIV in Fiji know their status, and some of those interviewed by the Guardian continue to live in denial or refuse to be tested.
“There are people blaming the (queer) community, blaming women for being irresponsible, there’s a lot of cyberbullying. Minorities are being attacked online,” says Mark Shaheel Lal, an activist living with HIV. “Now it’s more of a scandal and people are scared.”
UNAIDS is also concerned about the spread of the virus in the Pacific, with an increase in cases seen in the Solomon Islands and Papua New Guinea. In November, Australian Foreign Minister Penny Wong announced AUD 48 million for Pacific countries to fight HIV/AIDS, while New Zealand committed NZ$ 4.2 million to Fiji in July.
The introduction of PreP – or pre-exposure prophylaxis – an HIV prevention drug, would be a game-changer, says Mitchell, who adds that an injection could be offered every six months to those most at risk.
This would be particularly important for women who are unable to promote safe sex practices with their partners. Two out of 100 pregnant women are now HIV positive. “You can’t hide a bottle of pills, but you can get an injection,” says Michell.
For now, women are already offered three HIV tests during pregnancy and sexual reproduction centers are operating in the three main hospitals.
________
“There are no miracles in the HIV response, it doesn’t happen overnight. Unfortunately people think it’s like Covid, it’s really not,” Mitchell says.
His team plans to open new clinics, integrate testing and treatment into GP services, work on risk reduction and hire at least 100 more people. He says the increase in cases means more people are getting tested, which is positive.
“Burnout is a major concern. We didn’t start work yesterday, we’ve been working for 21 months. It’s difficult, and the difficulty is that all of this is preventable. This shouldn’t be happening.”
But in many areas, including rural communities, access to treatment continues to lag. Kalesi Volatabu, founder and activist of Drug Free World Fiji, is still haunted by the 15-year-old girl she met when she began campaigning for a safe needle program six years ago. A drug mule who smuggled methamphetamine into New Zealand and Australia, she had the names of the three main veins on the back of her hand; breakfast, lunch and dinner.
“We had no idea of the seriousness, the scale of the drug trade in this country, of the HIV crisis. Even I was naive, at first, and it was not reported for a very long time. We didn’t act then – will we now?”
*The name has been changed
Gn Health
