Fiji's Alarming HIV Crisis: A Study in Drug Use and Shared Blood

Ten: that's the age of the youngest person with HIV that Sesenieli Naitala has ever met.

When she first started Fiji's Survivor Advocacy Network in 2013, that young boy was yet to be born. Now he is one of thousands of Fijians to have contracted the bloodborne virus in recent years – many of them aged 19 or younger, and many of them through intravenous drug use.

More young people are using drugs, Ms Naitala, whose organisation provides support to sex workers and drug users in the Fijian capital Suva, tells the BBC. He (the boy) was one of those young people that were sharing needles on the street during Covid.

Over the past five years, Fiji – a tiny South Pacific nation with a population of less than a million – has become the locus of one of the world's fastest growing HIV epidemics.

In 2014, the country had fewer than 500 people living with HIV. By 2024 that number had soared to approximately 5,900 – an elevenfold leap.

That same year, Fiji recorded 1,583 new cases – a thirteenfold increase on its usual five-year average. Of those, 41 were aged 15 or younger, compared to just 11 in 2023.

Such figures prompted the country's minister for health and medical services to declare an HIV outbreak in January. Last week, assistant health minister Penioni Ravunawa warned Fiji may record more than 3,000 new HIV cases by the end of 2025.

This is a national crisis, he said. And it is not slowing down.

The BBC spoke to multiple experts, advocates and frontline workers about the reasons for such a meteoric rise in case numbers. Several pointed out that, as awareness around HIV spreads and stigma diminishes, more people have been coming forward and getting tested.

At the same time though, they also noted that countless more remain invisible to the official figures – and that the true scale of the issue is likely much bigger than even the record-breaking numbers suggest.

'Sharing the blood'

Underpinning Fiji's HIV epidemic is a spiralling trend of drug use, unsafe sex, needle sharing and bluetoothing.

Otherwise known as hotspotting, this latter term refers to a practice where an intravenous drug user withdraws their blood after a hit and injects it into a second person – who may then do the same for a third, and so on.

Kalesi Volatabu, executive director for the NGO Drug Free Fiji, has seen it happen firsthand. Last May, she was on one of her regular early morning walks through the Fijian capital of Suva, offering support and education to drug users on the streets, when she turned a corner and saw a group of seven or eight people huddling together.

I saw the needle with the blood – it was right there in front of me, she recalls. It's not just needles they're sharing – they're sharing the blood.

Bluetoothing has also been reported in South Africa and Lesotho, two countries with some of the world's highest rates of HIV. In Fiji, the practice became popular within the past few years, according to both Ms Volatabu and Ms Naitala.

One reason for its appeal, they explain, is a cheaper high: multiple people can chip in for a single hit and share it among themselves. Another is the convenience of only needing one syringe.

These can be difficult to come by in Fiji, where pharmacies, under police pressure, often demand prescriptions for syringes, and there is a lack of needle-syringe programmes.

In August 2024, Fiji's Ministry of Health and Medical Services (MOH) recognised bluetoothing as one of the drivers for the country's rise in HIV cases. Another was chemsex, where people use drugs - often methamphetamine - before and during sexual encounters.

Kids on meth

Fiji has become a major Pacific trafficking hub for crystal meth over the past 15 years. A large part of this is due to the country's geographic location between East Asia and the Americas – some of the world's biggest manufacturers of the drug - and Australia and New Zealand – the world's highest-paying markets.

During that same period, meth has spilled into and spread throughout local communities, developing into a crisis that, like HIV, was recently declared a national emergency.

And according to those on the frontlines, the age of users is trending downwards.

Fiji's most recent national HIV statistics cite injectable drug use as the most common known mode of transmission, accounting for 48% of cases. Sexual transmission accounted for 47% of cases.

Everyone the BBC spoke to agreed that lack of education is a central factor in the epidemic. The Ministry of Health also found that of the new HIV cases, 20% were from intravenous drug use.

The avalanche

José Sousa-Santos, head of the Pacific Regional Security Hub at New Zealand's University of Canterbury, says a perfect storm is brewing. He warns that support systems - the nursing and the ability to distribute or access drugs for treatment of HIV - aren't in place.

Following its declaration of an outbreak, the Fijian government has sought to improve its HIV surveillance. But experts indicate that many who need treatment remain unaccounted for, with severe limitations on resources and monitoring systems.