Fiji declares HIV national emergency as crystal meth use drives a 12-fold rise in cases since 2010

Fiji, long recognized as a Pacific tourism destination, is now contending with what public health specialist Jason Mitchell described at the AIDS 2026 conference in Rio de Janeiro as the fastest-growing HIV epidemic in the world. The country's health minister has stated that approximately 9,000 to 12,000 people are living with HIV, though only 5,676 cases have been officially diagnosed. Two-thirds of cases are in people ages 20 to 34, according to Mitchell, who leads Fiji's HIV response.

Public health officials have identified crystal meth as a central driver. Fiji has long served as a transit hub for methamphetamine moving between South America and Australia and New Zealand, but COVID-era disruptions appear to have accelerated domestic use. Dr. Sailosi Soqo, a member of the national HIV response team, said that travel restrictions and increased border security during the pandemic reduced the drug's onward movement, causing supplies to remain in Fiji and seed a domestic market that had not previously existed at scale. Rising unemployment and worsening mental health during lockdowns are cited as contributing factors, with Soqo noting that community reports describe children as young as 9 using injectable drugs.

A particularly high-risk behavior driving HIV spread is a practice known locally as "bluetoothing" or "hotspotting," in which one person injects a drug and another then injects that person's blood. Soqo attributed its prevalence to a combination of Fijian cultural norms around sharing, a scarcity of clean needles, and law enforcement crackdowns on needle availability. Mitchell estimated that on average, one infected person passes the virus to 10 others. Sexual transmission also accounts for roughly 50% of new 2025 cases, according to Soqo, and a 2021 survey found condom use was low — 24% among men and 9% among women with multiple partners in the prior year.