Fiji's HIV Crisis: Meth Use and Stigma Fuel World's Fastest-Growing Epidemic
Fiji is grappling with the world's fastest-growing HIV epidemic, where escalating methamphetamine use, unsafe injecting practices, and profound cultural stigma are creating a devastating public health crisis. New HIV cases more than tripled between 2023 and 2024, with over 1,200 diagnoses in just the first six months of 2025. This alarming surge occurs against a backdrop of declining global aid and positions Fiji at the epicenter of a preventable tragedy.
A Family's Heartbreaking Discovery
Clare's world shattered when doctors asked to test her month-old baby, Andi, for HIV. After days of watching her daughter cling to life in a Fijian hospital, undergoing multiple CPR attempts and chest drains, the diagnosis confirmed her worst fears. Both Clare and her husband tested positive, and during late pregnancy or breastfeeding, Clare had unknowingly transmitted the virus to her daughter. "I thought it was the end of the world," Clare, in her early twenties, recalls. Her husband, an injecting drug user, claimed caution, but the family now faces a lifetime of managing a chronic disease for their child.
This young family represents thousands caught in Fiji's escalating crisis. The United Nations identifies Fiji's location as a drug-running hub, with rising local methamphetamine consumption, unsafe needle-sharing, and limited access to clean syringes as primary drivers. Compounding these factors are critically low health awareness, deep-seated cultural stigma, and inadequate testing and treatment infrastructure.
Children Bear the Brunt of the Epidemic
The epidemic has transformed into a disease disproportionately affecting the young and addicted. Approximately half of HIV transmissions are linked to contaminated needle sharing or drug preparation. Now, a terrifying wave is impacting the most vulnerable: babies born with HIV due to mother-to-child transmission.
Health authorities report one baby diagnosed weekly from such transmission, with intensive care units seeing an influx of infants requiring life support. Dr. Jason Mitchell, head of Fiji's HIV epidemic response, reveals one child under five dies every month from HIV/AIDS complications. "It is the figure that I feel most pained by, because it is preventable," he states. "It is inexcusable to have any more children born with HIV."
Stigma and Misinformation as Major Barriers
Fiji, an archipelago of over 300 islands with a population of about 930,000, is a deeply Christian nation where religion intertwines with traditional beliefs. Distrust of Western medicine remains common among the iTaukei (Indigenous Fijians), who constitute roughly half the population and represent about 90% of HIV diagnoses.
Christopher Lutukivuya, a 38-year-old HIV activist living with the condition since 2013, describes the pervasive stigma: "If you're living with HIV you're sinful, you're going to hell, period. Because we've been grounded in religious values, that whatever the preacher says about 'HIV is a sin' it is seeded in our heart." He has witnessed friends expelled from homes, forced into basements, or choosing suicide over disclosure.
Dr. Mark Jacobs, WHO representative for the South Pacific, notes Fiji faces basic knowledge gaps reminiscent of 1980s Australia: "This includes not knowing about the dangers of sharing needles, the lack of a safe needle programme, knowledge of treatment, and acceptance of condom use." In villages, some leaders blame mothers for transmitting HIV to babies or are unaware the disease is treatable.
Youth Addiction and Urban Desperation
On the streets of Suva, Fiji's capital, children survive through mugging or drug pushing. Many first encounter methamphetamine through injection—a quicker, cheaper method allowing group highs. Dr. Dashika Balak observes: "Most of the children that we speak with prefer staying on the streets because this is where they get the drugs. They are among their friends, and this is where they find what they call love."
At the Kauwai Youth Restoration Home, social workers rehabilitate youth like Isac, 17, and Nemaia, 15, who contracted HIV through needle sharing after becoming addicted to meth. Isac recalls his physical decline: "I was fit. And after that, I became slim. I lost all my weight." Through structured routines, therapy, and reintroduction to society and faith, both boys are rebuilding their lives, with Isac back in school aspiring to be an accountant.
Glimmers of Hope and Preventative Measures
Amid the crisis, dedicated professionals are making incremental progress. Dr. Kesaia Tuidraki, chief medical officer at Medical Services Pacific, provides HIV prophylaxis to rape victims, most under 18, sometimes involving multiple family members. "It's hard to stomach when the people who are impacted by this are completely innocent," she admits.
Her organization has expanded testing via mobile clinics in Suva and remote villages. Early detection in pregnancy allows antiretroviral treatment to suppress the virus, significantly reducing mother-to-child transmission risk.
Renata Ram, UNAids adviser for the Pacific, highlights efforts to introduce Pre-exposure Prophylaxis (PrEP) within six months through tablets, injectables, and discreet vaginal rings. "Most women that are being picked up right now are not injecting drug users, not sex workers. The majority of them are married women who get HIV within their marriage and who do not have much say in terms of their protection," she explains. The program aims to "reduce harm while we are still working on the human rights aspect of things."
Community Responses and Safe Havens
Authorities anticipate upgrading the pandemic threat level to a generalized epidemic soon. While the Fijian government allocated $10 million last year, matched by Australian and New Zealand support, Dr. Mitchell emphasizes: "It cannot just be business as usual."
UNAids data estimates up to 8,900 people living with HIV in Fiji, though official figures likely undercount due to stigma-related underreporting. In villages like Nataleira, elders express concern about generational impact. "I don't want one of my family members to be affected because that virus kills a generation," says Rusiate Togotogorua, a local headteacher.
On Nadi's outskirts, the Daulomani Safe House, founded by trans woman and former sex worker Edwina Biyau, shelters 68 survivors of drugs, HIV, and violence. Biyau challenges denial: "You can say that you're innocent. You're not going out. You're just going to church. But how about your husband? How about your uncle? How about your brother? How about your children?"
She introduces newcomers to Josy Ralulu, a sex worker diagnosed in 2022 who now thrives on medication. Ralulu's initial shock—"I thought I was dead"—turned to hope when doctors assured her treatment enables normal life. Biyau advocates for love and hope: "You got infected with HIV. But that's not the end of the world. You know, you can write a new chapter."
After seven months on life support, Clare's daughter Andi is now a happy two-year-old with a scar on her ribcage. She takes antiretroviral medication crushed in juice, though hospital visits continue. Clare's vigilance reflects a parent's determination: "If you want your child to be alive, you just have to follow what they say." Her story underscores the human cost of an epidemic fueled by addiction, stigma, and systemic failures—a crisis demanding urgent, compassionate response.
