Best known as a tropical paradise and honeymoon destination, the island nation of Fiji now has the unfortunate distinction of facing two intertwined epidemics: HIV and addiction to crystal meth.
With HIV cases rising by 12-fold between 2010 and 2025, in mid-September, Fiji's government declared a national emergency. Estimates are that there are upward of 9,000 cases; the country's health minister has announced that 1 in 60 adults are now living with HIV.
At the July AIDS 2026 conference in Rio, Jason Mitchell, a public health specialist leading Fiji's HIV response, described it as the fastest-growing HIV epidemic in the world, noting that two-thirds of cases are in those ages 20-34. "Our young, active, productive population is currently being infected with HIV, and unless we find solutions quickly, this will continue to get worse," he says.
A key cause is another parallel epidemic — the rampant use of crystal meth among the nation's youth, who often inject it. That has led to transmission through shared needles.
"Two of my best friends passed away," says Mark Lal, a 25-year-old HIV activist from Fiji's capital of Suva. "The majority of my friends, they got HIV through crystal meth."
The meth factor
Crystal meth has long been available to some degree within Fiji — the islands are a known transit hub for the drug between South America and the eventual destinations of Australia and New Zealand. But since COVID, meth use has soared, something Fiji's HIV experts attribute to the lethal combination of rising unemployment and ever more accessible drugs.
"COVID was a difficult time for Fijians," says Sailosi Soqo, a doctor working on the national HIV response team. "Most lost their jobs, got less hours or were stuck at home. At the same time, we suspect that the travel restrictions, along with increased border security, decreased the movement of narcotics onto their target countries. Drugs that would otherwise have moved on stayed in Fiji, seeding this domestic market which didn't really exist before."
Soqo suggests that spiraling unemployment, combined with worsening mental health due to the impacts of lockdown, led to more young Fijians turning to meth, even preteens.
"The communities I work with report children as young as 9 using injectable drugs," he says.
According to Dashika Balak, a doctor who leads Fiji's national HIV treatment, care and support efforts, the risk of HIV transmission has also been exacerbated by a nationwide shift from smoking meth to injecting it. This includes the so-called "bluetoothing" or "hotspotting" practice where one person injects the drug and then another person injects their blood.
Bluetoothing is known to occur in settings of extreme poverty as a cheaper way of getting high. But Mitchell believes that its popularity in Fiji is partially because sharing all manner of things is a part of national culture — both alcohol and the ceremonial drink kava are consumed via a communal glass or bowl — and partially due to a scarcity of needles. Soqo says that law enforcement in Fiji has cracked down on needle availability in an attempt to curb meth use, something that he believes has inadvertently encouraged bluetoothing.
Unfortunately, bluetoothing has fueled the spread of HIV. Reports suggest that on average, one infected person in Fiji will pass the virus on to 10 others. "You add the existing culture in Fiji of sharing things, plus the limited access to clean injecting equipment, and you get the perfect storm for HIV transmission," says Soqo.
Fiji's HIV epidemic is also spreading in other ways, including risky sexual practices. "What we do know is that sexual intercourse, as a transmission route, made up roughly 50% of the new HIV cases for 2025," says Soqo.
Balak says that low condom use is encouraging the spread of HIV. A 2021 survey found that among 15- to 49-year-olds with multiple sexual partners in the past year, only 24% of men and 9% of women used a condom the last time they had sex. Lal can attest to this — having contracted HIV himself in the summer of 2024 through unprotected sex with a male partner. "You let your guard down once, and boom, it happens," he says.
Preventing a permanent epidemic
The surge in cases has led to an influx of foreign aid to support new HIV testing, prevention and treatment programs. Concerned about rising rates of infections and the potential for the epidemic to spread more widely through the Pacific, the Australian government announced a new $48 million funding package in August. According to a statement to NPR, the government is committed to supporting Fiji's HIV response to prevent new infections, improve early diagnosis and expand access to treatment.
One of the first priorities for Australian organizations working with Fiji is to make HIV testing available at all antenatal clinics. In 2025, 59 babies were born with HIV.
"We're trying to get a reliable rollout of these tests so that every single pregnant woman anywhere in the country will be tested for HIV," says Storm Holwill, a public health physician working at Melbourne's Peter Doherty Institute for Infection and Immunity.
Anyone who is HIV positive would then be placed on viral-suppressing medications known as antiretrovirals to limit the chances of HIV being passed on in utero.
Blocking new infections on a wider scale is far more challenging. Meth use is most prevalent in some of Fiji's poorest and most vulnerable populations, many of whom have no fixed address. This makes it difficult for medical professionals to test and prescribe treatments.
Balak explains that while anywhere between 9,100 and 12,000 people in Fiji are thought to have HIV, only 5,676 of these cases have been officially diagnosed. Even fewer are regularly taking antiretrovirals to keep their condition under control.
"Some stop treatment, and some cannot be reached because their contact details are incomplete," she says.
This means that while Australia's aid is providing Fiji with plentiful access to medications such as PrEP pills to block HIV infections, getting these drugs to the right people is not straightforward.
"We've just introduced PrEP about two months back," says Mitchell. "The uptake has been very slow, while at the same time, antiretroviral treatment is also freely available, but it's currently sitting on shelves."
Lal argues that one of the biggest problems is a lack of awareness. He says many people in Fiji have never heard of these medications. Even for those who have, obtaining them requires a lengthy journey to one of three dedicated clinical centers, either in the cities of Suva and Lautoka or the town of Labasa.
With Fiji's population spread across more than 100 islands, Lal says that such a journey likely deters many people from seeking care. "If they know the medications are far away, they won't even want to access them," he says. "In a country like ours where religion is big, people would — rather than go — pray and believe that God will heal them."
Mobile clinics and clean needles
To improve access to PrEP and antiretrovirals, Balak and her colleagues have started creating dedicated HIV response teams in 21 locations across the country. "They will soon be able to order their own antiretrovirals [and] dispense and fully manage their patients on their own," she says.
To track down more people living with HIV, the team is also recruiting and training peer support workers — including some existing meth users who are HIV positive. Balak says she hopes that this could be a way to connect more of the people at most risk of contracting HIV with medical teams.
Methamphetamine use remains a tense issue, and some of the proposed schemes to address the spread of HIV have clashed with law enforcement.
To break the chains of infections stemming from contaminated needles, Soqo has proposed supplying thousands of sterile needles and syringes to communities of methamphetamine users. However, Soqo says the government is blocking the plan. "The director prosecutor has told us, 'If you hand these out, we'll arrest you, and we'll charge you for aiding and abetting,'" he says. "As a result, I now have a warehouse full of needles and syringes, just collecting dust." Fiji's government did not respond to a request for comment from NPR.
However, there is more optimism that other approaches could make a significant difference. Fiji is set to receive supplies of the drug lenacapavir, an injectable form of PrEP that provides those at risk of infection due to sexual behavior or drug use near 100% protection from HIV. Because this new preventive drug only needs to be administered twice yearly, Mitchell believes it will be easier to convince people to use it compared with daily pills.
To prevent women from contracting HIV from their partners while pregnant, antenatal clinics hope to start offering vaginal rings, which slowly release a protective antiretroviral drug over the course of a month.
Such innovations are badly needed. Projections suggest that if the epidemic continues at its current pace, 25,000 people in Fiji will be living with HIV by 2029, figures that Soqo says would push Fiji's fragile health system to the brink of collapse.
"Time is not on our side," says Soqo. "With the current numbers, we're already struggling. All our main hospitals are overcrowded and have chronic issues with staffing shortages. Our tuberculosis hospitals and primary healthcare facilities are telling us they're seeing an increase in advanced HIV cases and are overwhelmed. Imagine what things will be like in three years' time. There is an urgent need for more action now."
David Cox is a freelance health journalist who has written for publications around the world, including NPR, The New York Times, Wired and The Guardian. He has a Ph.D. in neuroscience.
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