Mark Shaheel Lal is the founder of Living Positive Fiji and a Reconciliation Officer for the Fiji Truth and Reconciliation Commission. He says: “The majority of my friends got HIV from crystal meth. » He was photographed at the AIDS conference in Rio de Janeiro, Brazil, in July.
Ian Cheibub for NPR
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Ian Cheibub for NPR
Best known as a tropical paradise and honeymoon destination, the island nation of Fiji now has the unfortunate distinction of facing two closely linked epidemics: HIV and crystal meth addiction.
With HIV cases increasing 12-fold between 2010 and 2025, in mid-September the Fiji government declared a state of national emergency. It is estimated that there are more than 9,000 cases; the country’s health minister announced that one in 60 adults are now living with HIV.
At the AIDS 2026 conference in Rio in July, Jason Mitchell, a public health specialist leading Fiji’s HIV response, described the world’s fastest-growing HIV epidemic, noting that two-thirds of cases are in the 20-34 age group. “Our young, active and productive population is currently infected with HIV, and if we do not find solutions quickly, the situation will continue to worsen,” he said.
Another major cause is another parallel epidemic: the widespread use of crystal meth among the country’s young people, who often inject it. This led to transmission through needle sharing.
“Two of my best friends have died,” says Mark Lal, a 25-year-old HIV activist from Suva, Fiji’s capital. “The majority of my friends got HIV from crystal meth.”
The meth factor
Crystal meth has long been available to some extent in Fiji – the islands are a known transit hub for the drug between South America and eventual destinations Australia and New Zealand. But since COVID, methamphetamine use has exploded, which Fijian HIV experts attribute to the deadly combination of rising unemployment and increasingly accessible drugs.
“COVID has been a difficult time for Fijians,” says Sailosi Soqo, a doctor working with the national HIV response team. “Most have lost their jobs, worked fewer hours, or been stuck at home. At the same time, we suspect that travel restrictions, along with increased border security, have diminished the movement of narcotics to their target countries. Drugs that otherwise might have been transported remained in Fiji, seeding this domestic market that didn’t really exist before.”
Soqo suggests that spiraling unemployment, combined with deteriorating mental health due to the impacts of the lockdown, has led more young Fijians to turn to methamphetamine, even preteens.
“The communities I work with report that children as young as 9 years old are injecting drugs,” he says.
According to Dashika Balak, a doctor who leads Fiji’s national HIV treatment, care and support efforts, the risk of HIV transmission has also been exacerbated by the nationwide shift from methamphetamine use to injection. This includes the practice of so-called “Bluetooth” or “hotspotting” in which one person injects the drug and then another person injects their blood.
Bluetoothing is known to be used in contexts of extreme poverty as a cheaper way to take drugs. But Mitchell believes its popularity in Fiji is partly due to the fact that sharing all kinds of things is part of the national culture – alcohol and the ceremonial drink, kava, are consumed in a communal glass or bowl – and partly to the scarcity of needles. Soqo claims law enforcement in Fiji has cracked down on the availability of syringes to try to curb methamphetamine use, which he says has inadvertently encouraged Bluetooth use.
Unfortunately, Bluetooth has contributed to the spread of HIV. Reports suggest that on average, one infected person in Fiji will pass the virus on to 10 other people. “You add Fiji’s existing culture of sharing things, plus limited access to clean injection equipment, and you have the perfect storm for HIV transmission,” says Soqo.
Fiji’s HIV epidemic also spreads in other ways, including unsafe sexual practices. “What we know is that sexual intercourse, as a route of transmission, accounted for about 50% of new HIV cases for 2025,” says Soqo.
Balak says low condom use promotes the spread of HIV. A 2021 survey found that among 15- to 49-year-olds who had multiple sexual partners in the past year, only 24% of men and 9% of women used a condom the last time they had sex. Lal can attest to this: he himself contracted HIV in the summer of 2024 during unprotected sex with a male partner. “You let your guard down once, and boom, it happens,” he says.
Preventing a permanent epidemic
The increase in cases has led to an influx of foreign aid to support new HIV testing, prevention and treatment programs. Concerned about rising infection rates and the possibility of the outbreak spreading more widely across the Pacific, the Australian government announced a new $48 million funding package in August. According to a statement to NPR, the government is committed to supporting Fiji’s HIV response to prevent new infections, improve early diagnosis and expand access to treatment.
One of the first priorities for Australian organizations working with Fiji is to make HIV testing available in all antenatal clinics. In 2025, 59 babies will be born with HIV.
“We’re trying to roll out these tests reliably so that every pregnant woman, everywhere in the country, is tested for HIV,” says Storm Holwill, a public health physician working at the Peter Doherty Institute for Infection and Immunity in Melbourne.
Any HIV-positive person would then be placed on antiviral treatment called antiretroviral to limit the risks of transmitting HIV in utero.
Blocking new infections on a larger scale is much more difficult. Methamphetamine use is most prevalent among some of Fiji’s poorest and most vulnerable populations, many of whom do not have a fixed address. This makes it difficult for healthcare professionals to test and prescribe treatments.
Balak explains that although between 9,100 and 12,000 people in Fiji are estimated to be HIV positive, only 5,676 of these cases have been officially diagnosed. Even fewer people take antiretroviral drugs regularly to control their condition.
“Some stop treatment, and some cannot be contacted because their contact details are incomplete,” she explains.
This means that while Australia’s aid gives Fiji widespread access to drugs such as PrEP pills to block HIV infections, getting these drugs to the right people is not simple.
Dr Jason Mitchell leads the national HIV epidemic and cluster response task force in Fiji.
Ian Cheibub for NPR
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“We just introduced PrEP about two months ago,” Mitchell says. “Adoption has been very slow, while at the same time antiretroviral treatment is also available for free, but it currently remains on the shelves.”
Lal says one of the biggest problems is lack of awareness. He says many people in Fiji have never heard of these drugs. Even for those who have them, obtaining them requires a long journey to one of three dedicated clinical centers, either in the towns of Suva and Lautoka, or in the town of Labasa.
With Fiji’s population spread across more than 100 islands, Lal believes such travel will likely deter many people from seeking treatment. “If they know the medicine is far away, they won’t even want to access it,” he says. “In a country like ours, where religion is important, people – rather than going there – pray and believe that God will heal them.”
Mobile clinics and clean needles
To improve access to PrEP and antiretrovirals, Balak and colleagues began creating dedicated HIV response teams in 21 sites across the country. “They will soon be able to order their own antiretrovirals (and) distribute and manage their patients entirely themselves,” she says.
To find more people living with HIV, the team is also recruiting and training peer supporters, including some meth users who are HIV positive. Balak says she hopes this could be a way to connect more people at highest risk of contracting HIV with medical teams.
Methamphetamine use remains a tense issue, and some of the programs proposed to combat the spread of HIV have clashed with law enforcement.
To break the chains of infections linked to contaminated needles, Soqo offered to provide thousands of sterile needles and syringes to methamphetamine-using communities. However, Soqo claims that the government is blocking this project. “The attorney general told us: ‘If you distribute them, we will arrest you and we will charge you with complicity,'” he says. “As a result, I now have a warehouse full of needles and syringes, which are just collecting dust.” The Fiji government did not respond to a request for comment from NPR.
However, some are more optimistic that other approaches could make a significant difference. Fiji is set to receive supplies of lenacapavir, an injectable form of PrEP that provides these…
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