Why THIS small pacific country is seeing a rapid surge in HIV cases among teens

Ten—the age of the youngest person with HIV that Sesenieli Naitala, a former sex worker and project coordinator at the Survival Advocacy Network has encountered. When she founded Fiji’s Survivor Advocacy Network in 2013, that child hadn’t yet been born. Today, he is one of thousands of Fijians infected with the virus, with many cases emerging among teenagers, often linked to intravenous drug use. “Drug use among young people is increasing,” Naitala was quoted as saying to BBC, whose organisation supports sex workers and drug users in Suva, Fiji’s capital. “He was part of a group sharing needles on the streets during the Covid period.”

Over the last five years, Fiji—a small Pacific island country with fewer than a million residents—has witnessed one of the fastest-growing HIV epidemics globally. In 2014, fewer than 500 people lived with HIV. By 2024, that number had surged to around 5,900, an elevenfold increase. That year alone, the country recorded 1,583 new infections, a thirteenfold rise compared to the five-year average, including 41 cases in children aged 15 or under, up from 11 in 2023. In response, Fiji’s health minister declared an HIV outbreak in January. Recently, assistant health minister Penioni Ravunawa warned the country could see over 3,000 new cases by the end of 2025. “This is a national emergency,” he said. “And it shows no signs of slowing.”

Experts attribute part of the increase to rising awareness and reduced stigma around HIV, prompting more people to get tested. Yet many infections likely go unreported, suggesting the true scale of the crisis is far larger than official numbers indicate.

Dangerous practices fuel spread

A key factor behind the epidemic is the increase in unsafe drug and sexual practices. One particularly alarming trend is ‘bluetoothing’, where an intravenous drug user draws blood after injecting a dose and passes it to another person, who may repeat the process with others. Kalesi Volatabu, executive director of Drug Free Fiji, witnessed this firsthand last May. During a morning walk in Suva, she saw a group of young people huddled together, sharing a single syringe and passing blood among them. “It’s not just needles—they’re sharing blood,” she was quoted as saying.

The practice, previously reported in South Africa and Lesotho, has recently gained popularity in Fiji. It offers a cheaper high and allows multiple users to share a single syringe, which can be hard to obtain due to prescription requirements and limited needle-syringe programs. Fiji’s Ministry of Health identified bluetoothing and chemsex—using drugs like methamphetamine before or during sexual activity—as key contributors to rising HIV rates. Notably, crystal meth in Fiji is mostly injected intravenously. Among 1,093 new HIV cases reported in the first nine months of 2024, around 20% were linked to injectable drug use.

Youth and methamphetamine

Fiji has become a regional hub for crystal meth trafficking over the past 15 years due to its location between major producers in East Asia and the Americas and lucrative markets in Australia and New Zealand. The drug has permeated local communities, creating a crisis recently declared a “national emergency.” Frontline workers report that the age of users is steadily decreasing.

National HIV data shows that 48% of infections are linked to injectable drug use, 47% to sexual transmission, and the majority of pediatric cases result from mother-to-child transmission. Both Ms. Volatabu and Ms. Naitala emphasize that lack of education is a central factor in the epidemic, and their organizations are working to raise awareness.

José Sousa-Santos, head of the Pacific Regional Security Hub at New Zealand’s University of Canterbury, warns of a looming disaster. “The concern is not only about the current crisis but the next three years. Fiji lacks the resources—medical staff, treatment access, and distribution systems—to manage this,” he was quoted as saying.