Fiji is grappling with what United Nations officials call one of the sharpest HIV surges anywhere on Earth, with new government and UN data showing infections have multiplied twelvefold in fifteen years, driven largely by a crystal methamphetamine epidemic and widespread needle-sharing among drug users.

The South Pacific nation of roughly 900,000 people — a longtime honeymoon and dive-tourism destination — declared a national HIV emergency earlier this month, and fresh reporting this weekend, including an NPR investigation published Saturday, lays out the scale of the crisis in stark detail: an estimated 9,000 to 9,100 people are now living with HIV in Fiji, roughly one in 60 adults, up from one in 167 just five years ago. The UNAIDS statement backing the declaration puts 2025's new-infection count at 2,016 — a sixteenfold jump from 2019 — including 59 babies born with the virus, 18 of whom died before their first birthday. Only about 39% of those infected know their status, and just 22% are receiving antiretroviral treatment.

From Smoking to Injecting

Health workers trace the acceleration to a shift in how Fijians use methamphetamine: a move from smoking the drug to injecting it, often with shared needles, compounded by a practice locally called "bluetoothing," in which users without their own supply are injected with blood drawn from someone already high. UNAIDS attributes more than 42% of cases with a known transmission route to injecting drug use, with over half linked to sexual contact. Jason Mitchell, who heads Fiji's National HIV Outbreak and Cluster Response Taskforce, told NPR the country's "young, active, productive population is currently being infected with HIV," with two-thirds of cases concentrated among 20- to 34-year-olds. Dr. Sailosi Soqo, a member of the national response team, said the scarcity of clean needles amid law-enforcement crackdowns has created "the perfect storm for HIV transmission." Mark Lal, a 25-year-old HIV activist who founded the peer-support group Living Positive Fiji, said the pattern is personal: "The majority of my friends, they got HIV through crystal meth," he told the outlet.

"IT IS ALSO A STARK REMINDER TO THE WORLD THAT AIDS IS NOT OVER."

That warning came from UNAIDS Executive Director Winnie Byanyima, who said in the agency's statement that "Fiji has recognized the urgency of the moment and is stepping up its response." Eamonn Murphy, UNAIDS' regional director for Asia and the Pacific, urged calm over stigma, noting that "HIV is not transmitted through everyday contact, and people on effective treatment with an undetectable viral load do not sexually transmit HIV." Fiji's government has since set up a cabinet subcommittee to clear policy barriers, including plans for a needle-and-syringe exchange program that will require legislative changes, alongside expanded free testing, wider access to antiretrovirals and the twice-yearly injectable PrEP drug lenacapavir. Australia, Fiji's largest bilateral donor, pledged a AU$48 million support package in August, according to reporting on the emergency.

Officials warn the trajectory is not close to peaking. Modeling cited by health authorities suggests Fiji could have 25,000 people living with HIV by 2029 if current trends hold — a caseload that would strain a health system already short on staff and running just three specialist clinical centers across more than 100 inhabited islands. For now, the response centers on 21 mobile HIV teams fanning out across the archipelago and a push to recruit HIV-positive former meth users as community outreach workers.