Fiji’s government declared a national emergency over HIV in mid-September, and the country’s health minister has said one in every 60 adults is now living with the virus, according to a report published on 26 September by NPR. The report identifies injected crystal meth as a key driver of the outbreak.
A note on sourcing. Everything below comes from that single NPR report. It was also republished by NPR member stations including Kansas Public Radio and Jefferson Public Radio, but those are syndicated copies of the same story, not independent confirmation. Where NPR does not name a study, an agency or a figure, this article says so rather than filling the gap.
Key facts
- HIV cases in Fiji rose 12-fold between 2010 and 2025, NPR reports, with estimates of upward of 9,000 cases.
- Jason Mitchell, the public health specialist heading Fiji’s National HIV Outbreak and Cluster Response Taskforce, told the AIDS 2026 conference in Rio de Janeiro in July that two-thirds of cases are in people aged 20 to 34.
- Only 5,676 cases have been officially diagnosed, against an estimated 9,100 to 12,000 people thought to be infected, according to Dashika Balak, the doctor leading national HIV treatment, care and support.
- NPR says reports suggest one infected person in Fiji passes the virus on to 10 others on average. NPR does not name the study, agency or dataset behind that figure, and this article cannot verify it independently, so it should be read as an unattributed estimate rather than an official rate.
- Fifty-nine babies were born with HIV in Fiji in 2025.
- Australia announced a new $48 million funding package in August; the report does not specify the currency.
- PrEP pills, which block HIV infection, were introduced about two months ago, Mitchell said, with very slow uptake.
- There are three dedicated clinical centres for treatment — in Suva, Lautoka and the town of Labasa — serving a population spread across more than 100 islands.
Why it matters
Mitchell described Fiji’s outbreak at the Rio conference as the fastest-growing HIV epidemic in the world, NPR reports. He warned that the people being infected are the country’s working-age population: “Our young, active, productive population is currently being infected with HIV, and unless we find solutions quickly, this will continue to get worse,” he told the outlet.
Australia’s aid decision was driven in part by concern the epidemic could spread more widely through the Pacific, according to NPR. In a statement to the outlet, the Australian government said it is committed to preventing new infections, improving early diagnosis and expanding access to treatment.
The economic weight of a working-age epidemic
The clearest economic signal in NPR’s reporting is demographic. If two-thirds of cases sit in the 20-to-34 bracket, as Mitchell told the Rio conference, then the epidemic is concentrated in the cohort that staffs tourism and services, pays income tax and raises school-age children. Mitchell’s phrasing — “young, active, productive population” — is a statement about national output as much as about health.
NPR’s report does not attach a dollar figure to lost productivity, to Fiji’s HIV spend or to the cost of the emergency response, and this article will not invent one. What the reporting does establish is where the costs sit. Antiretrovirals are free at the point of care but, in Mitchell’s words, “currently sitting on shelves”, so money already spent on medicine is not converting into suppressed viral loads or into people staying at work. With only three dedicated clinical centres, patients on outer islands absorb the travel cost of treatment themselves, a barrier activist Mark Shaheel Lal says pushes people to give up. And 59 infants born with HIV in 2025 each represent a lifetime of publicly funded treatment. The $48 million Australia announced in August is a sign of how much of the response is being externally financed.
In NPR’s account the causation also runs the other way. Sailosi Soqo, a doctor on the national HIV response team, linked rising drug use to job losses, reduced working hours and worsening mental health during COVID lockdowns. On that telling an economic shock helped create the domestic meth market now driving infections among working-age Fijians — and the epidemic is in turn drawing down the workforce that shock already damaged.
The meth link
Lal, a 25-year-old HIV activist from Suva who founded Living Positive Fiji and works as a reconciliation officer for the Fiji Truth and Reconciliation Commission, told NPR that two of his best friends have died. “The majority of my friends, they got HIV through crystal meth,” he said. Lal said he himself contracted HIV in the summer of 2024 through unprotected sex with a male partner.
Balak said transmission risk has been worsened by a nationwide shift from smoking meth to injecting it, NPR reports. That includes a practice known as “bluetoothing” or “hotspotting”, in which one person injects the drug and another then injects that person’s blood.
Soqo said law enforcement has cracked down on needle availability to curb meth use, which he believes has inadvertently encouraged bluetoothing. Mitchell attributed its spread partly to a scarcity of needles and partly to a culture in which items are shared, noting that both alcohol and kava are consumed from a communal glass or bowl. Soqo also told NPR that sexual intercourse accounted for roughly 50% of new cases in 2025, so injecting is one pathway among two large ones, not the whole picture.
How the drugs stayed
NPR reports Fiji has long been a known transit hub for crystal meth moving from South America toward Australia and New Zealand — trafficking that has already prompted calls for defence support for police tackling organised crime.
Soqo said travel restrictions and increased border security during COVID reduced the onward movement of narcotics, so drugs that would otherwise have moved on stayed in Fiji and seeded a domestic market that had not really existed before. He also told NPR that the communities he works with report children as young as nine using injectable drugs.
Medicine on the shelves
Mitchell said antiretroviral treatment is freely available but “it’s currently sitting on shelves”, according to NPR. Balak said meth use is most prevalent in some of Fiji’s poorest and most vulnerable populations, many of whom have no fixed address, making testing and prescribing difficult. She added that low condom use is helping the virus spread: NPR cites a 2021 survey of 15- to 49-year-olds with multiple partners in the past year in which only 24% of men and 9% of women used a condom the last time they had sex.
Lal argues the bigger obstacle is awareness, saying many Fijians have never heard of these medications. Those who have must travel to Suva, Lautoka or Labasa, a journey he says deters people spread across more than 100 islands. In a country where religion is big, he told NPR, some would pray and believe God will heal them rather than make the trip.
Figures to watch
The report carries more than one estimate of the caseload, and does not reconcile them: the health minister’s one-in-60 figure for adults, an estimate of upward of 9,000 cases, and Balak’s range of 9,100 to 12,000 people thought to be infected — against 5,676 confirmed diagnoses. The onward-transmission figure of one person infecting 10 others is attributed by NPR only to unnamed “reports”. Readers should treat all four numbers as estimates of different things measured in different ways rather than as a single official count.
What happens next
NPR’s report points to a handful of concrete next steps rather than a published timetable. Storm Holwill, a public health physician at Melbourne’s Peter Doherty Institute for Infection and Immunity, said the first priority for the Australian organisations involved is HIV testing at every antenatal clinic in the country, with pregnant women who test positive started on antiretrovirals to limit transmission in utero. Mitchell’s task is to turn the very slow uptake of PrEP, introduced about two months before the report, into real uptake, and to move the antiretrovirals off the shelves and into patients.
The report does not say when Australia’s $48 million will reach clinics, how long the national emergency declaration will run, or what the government’s full response plan contains beyond the taskforce Mitchell heads. Those are the measures to watch over the coming months: whether new diagnoses start closing the gap on the 9,100-to-12,000 estimate, whether the 5,676 people already diagnosed stay on treatment, and whether needle policy shifts away from the crackdown that clinicians told NPR is pushing people toward sharing blood.
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Frequently Asked Questions
How many of Fiji’s estimated HIV cases have actually been diagnosed?
Dashika Balak, the doctor leading Fiji’s national HIV treatment, care and support efforts, told NPR that between 9,100 and 12,000 people in Fiji are thought to have HIV but only 5,676 cases have been officially diagnosed. She said even fewer are regularly taking antiretrovirals, because some stop treatment and others cannot be reached as their contact details are incomplete.
Is injecting drug use the only way HIV is spreading in Fiji?
No. Sailosi Soqo, a doctor on the national HIV response team, told NPR that sexual intercourse accounted for roughly 50% of new HIV cases in 2025. Activist Mark Shaheel Lal said he contracted HIV in the summer of 2024 through unprotected sex with a male partner.
What did Fiji’s condom-use survey find?
According to NPR, a 2021 survey of 15- to 49-year-olds who had multiple sexual partners in the past year found that only 24% of men and 9% of women used a condom the last time they had sex. Balak said low condom use is encouraging the spread of HIV.
Which age group is most affected, and why does that matter economically?
Jason Mitchell, the public health specialist heading Fiji’s National HIV Outbreak and Cluster Response Taskforce, told the AIDS 2026 conference in Rio de Janeiro in July that two-thirds of cases are in people aged 20 to 34 — the core of the working-age population. He said that unless solutions are found quickly the situation will keep getting worse. NPR’s report does not quantify the cost to Fiji’s health budget or to national output.
What is being done about babies born with HIV in Fiji?
NPR reports that 59 babies were born with HIV in Fiji in 2025, and that a first priority for Australian organisations is HIV testing at every antenatal clinic. Storm Holwill, a public health physician at Melbourne’s Peter Doherty Institute for Infection and Immunity, said the aim is for every pregnant woman anywhere in the country to be tested, with those who are positive put on antiretrovirals to limit transmission in utero.
What has Australia pledged, and when does the money land?
NPR reports Australia announced a new $48 million funding package in August, without specifying the currency, and that the decision was driven in part by concern the epidemic could spread more widely through the Pacific. In a statement to NPR, the Australian government said it is committed to preventing new infections, improving early diagnosis and expanding access to treatment. The report does not publish a rollout timeline.
