Fiji’s HIV epidemic escalates: New rapid assessment highlights urgent gaps in access to safe injecting equipment, HIV prevention, and stigma-free care among people who inject drugs

A new rapid assessment reveals that unsafe injecting practices, driven by an absence of harm reduction services such as needle/syringe programmes, are putting people who inject drugs in Fiji at increased risk of HIV transmission. The findings come as the Pacific island-nation continues to face one of the fastest growing HIV epidemics in the world.

Commissioned by the World Health Organization’s (WHO) Division of Pacific Technical Support and the United Nations Development Programme (UNDP), the assessment was carried out on the request of Fiji’s Ministry of Health and Medical Services (MHMS) by the Kirby Institute at the University of New South Wales, Fiji National University and the Australian Injecting and Illicit Drug Users League (AIVL). The study, funded by The Global Fund, provides an in-depth assessment of drug use, risk behaviours, health-seeking behaviours, and gaps in service delivery, to strengthen Fiji’s public health response.

The study combined a desk review of quantitative data, one-on-one interviews with 56 people who inject drugs and five talanoas - a traditional, inclusive way of storytelling and dialogue - held with 50 key informants representing civil society, health care workers, government ministries, law enforcement agencies, and faith-based organizations. 

HIV cases in Fiji, which has a population of just under 1 million, have been rising sharply. In 2024, 1583 new HIV cases were reported nationally, while 1226 cases were notified in the first six months of 2025 alone. UNAIDS modelled estimates suggest that the total number of people living with HIV in Fiji is higher and has been increasing rapidly from around 2000 in 2020 to an estimated 6100 in 2024. Among people starting HIV treatment in 2024, 48% were people who inject drugs, highlighting the disproportionate impact on this group.

All participants in the rapid assessment interviews reported that because of a lack of access to sterile needle/syringes, they had at some time reused a needle/syringe after someone else. This places them at high risk of HIV, viral hepatitis, and other injection-related infections. While so-called “bluetoothing” has been widely reported in the media, the researchers found little evidence of this high-risk practice, which involves sharing blood between users after one person has injected a drug.

Methamphetamine was the most commonly injected drug. Many participants reported that their first injection – often with a potentially contaminated needle/syringe – occurred when trying the drug for the first time. This means that people, particularly young people, are at risk of HIV and hepatitis from the very first moment they use drugs. Compounding the issue, most had low awareness of HIV, and many faced difficulties accessing HIV testing and treatment services.

The most pressing recommendation of the rapid assessment is to make sterile needle/syringes available and accessible to people who inject drugs. Needle/syringe programmes (NSP) are an evidence-based, public health and human rights intervention that enables people who inject drugs to protect their health and access essential services without stigma.