The increasing number of HIV infections in Fiji has raised significant concerns across the Pacific region, with UNAIDS Asia Pacific Regional Director Eamonn Murphy warning that the surge in cases jeopardizes the entire region. In January 2024, Fiji’s Ministry of Health officially declared an HIV outbreak following the identification of 1,093 new cases between January and September—three times the number reported during the same period in 2023.
According to the World Health Organization (WHO), an outbreak is defined as a situation where the number of cases surpasses normal expectations. While similar to an epidemic, an outbreak is generally confined to a specific geographic area. The formal declaration of an outbreak facilitates immediate public health interventions and the mobilization of both national and international resources to address the crisis effectively.
Underlying Causes of the HIV Outbreak
The surge in HIV infections in Fiji has been linked to the country’s escalating methamphetamine crisis. As a major transit point for drug trafficking to Australia and New Zealand, Fiji has seen an increase in local drug use. Preliminary data from the Ministry of Health indicates that approximately 50% of newly diagnosed individuals receiving antiretroviral therapy contracted HIV through injecting drug use.
However, the crisis is not solely attributable to drug use. Broader socio-economic factors such as rapid urbanization, homelessness, and unemployment have contributed to high-risk behaviors. Additionally, the erosion of traditional cultural ties and increasing social disconnection have exacerbated the situation. Reports suggest that children as young as eight are engaging in drug use, prostitution, and street begging, further fueling concerns about deteriorating societal values.
Low levels of HIV awareness and the persistence of social stigma continue to compound the issue. Many individuals are reluctant to undergo testing, and those diagnosed often hesitate to seek medical care. A 2021 survey revealed that fewer than one-third of individuals aged 15 to 24 possessed comprehensive knowledge about HIV prevention. Furthermore, a decade of underfunding and diminished international support has weakened Fiji’s HIV prevention initiatives, leading to a decline in health services and treatment accessibility.
Implications for the Pacific Region
Fiji serves as a regional hub for education and commerce, attracting students and workers from neighboring island nations. The movement of individuals to and from Fiji increases the risk of the virus spreading undetected to other Pacific nations. Additionally, Fiji remains a popular tourist destination, with visitors potentially engaging in behaviors that heighten their risk of exposure, such as drug use and unprotected sexual activities.
The tourism sector, a critical component of Fiji’s economy, may also face reputational damage. The country is still recovering from the economic impact of the COVID-19 pandemic, and an HIV crisis threatens to undermine efforts to promote Fiji as a safe and attractive destination. Furthermore, Fiji’s high rate of outward migration—recorded at 5% net in 2023—heightens concerns about the virus spreading through established migration pathways, including the Pacific Australia Labour Mobility scheme and New Zealand’s recognized seasonal employer program.
Beyond public health, the economic consequences of the outbreak are substantial. The financial burden on affected households due to lost income and increased healthcare expenses can be significant. Additionally, the crisis will divert government resources, potentially impacting national and regional economic stability.
Strategies to Address the Crisis
In response to the outbreak, Fiji’s Ministry of Health has implemented a 90-day HIV Outbreak Response Plan aimed at accelerating high-impact interventions. This plan includes harm reduction initiatives, widespread condom distribution, and the promotion of pre-exposure prophylaxis (PrEP) to prevent new infections. The longer-term HIV Surge Strategy 2024–2027 aims to improve Fiji’s healthcare system in line with the UN’s “95-95-95” targets, which state that 95% of people with HIV should be diagnosed, 95% of those diagnosed should get treatment, and 95% of those on treatment should achieve viral suppression.
Despite these efforts, statements from the Health Minister indicate that the outbreak is evolving more rapidly than the country’s current healthcare services can accommodate. As a result, the government is intensifying its international assistance. The United Nations Development Programme (UNDP) has delivered 3,000 antiretroviral treatment courses to Fiji, while the Australian government’s Indo-Pacific HIV Partnership with UNAIDS is providing additional support to scale up prevention efforts. Furthermore, with backing from Australia and New Zealand, the Fiji Reproductive and Family Health Association is collaborating with experts to enhance awareness, prevention, and treatment strategies.
The Role of Australia and New Zealand
As key regional stakeholders, Australia and New Zealand bear a shared responsibility in addressing the crisis. The demand for illicit substances in these nations contributes to the drug trafficking networks fueling Fiji’s methamphetamine crisis and, consequently, the HIV outbreak. Strengthening anti-narcotics initiatives and addressing domestic drug consumption are essential components of an effective response.
Furthermore, both countries have an obligation to safeguard the well-being of Fijian migrant workers. Providing education, routine screening, and access to HIV treatment for Pacific communities is imperative. Currently, preventive treatments such as PrEP are not widely funded for migrants in either Australia or New Zealand, posing additional challenges in curbing the outbreak’s spread.
Additionally, educating tourists about potential health risks and encouraging preventive measures is crucial in minimizing the transmission of HIV.
The declaration of Fiji’s HIV outbreak underscores the nation’s commitment to addressing the crisis. However, sustained regional cooperation will be essential for success. Australia and New Zealand have the capacity to influence the trajectory of this outbreak through policy support, funding, and collaboration with Pacific partners. A unified approach will not only mitigate the spread of HIV but also safeguard public health and economic stability throughout the region.
