Meth is a key driver in Fiji's fast-growing HIV epidemic: 1 in 60 adults are affected
asserted
adults → grow → epidemic
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.
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nation → know → meth
With HIV cases rising by 12-fold between 2010 and 2025, in mid-September, Fiji's government declared a national emergency.
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government → rise → 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.
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adults → be → 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.
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thirds → lead → ages
"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.
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he → infect → solutions
A key cause is another parallel epidemic — the rampant use of crystal meth among the nation's youth, who often inject it.
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who → inject → it
That has led to transmission through shared needles.
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That → lead → needles
"Two of my best friends passed away," says Mark Lal, a 25-year-old HIV activist from Fiji's capital of Suva.
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Lal → pass → Suva
"The majority of my friends, they got HIV through crystal meth."
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they → get → 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.
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islands → know → Australia
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.
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experts → soar → unemployment
"COVID was a difficult time for Fijians," says Sailosi Soqo, a doctor working on the national HIV response team.
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Soqo → say → team
"Most lost their jobs, got less hours or were stuck at home.
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Most → lose → 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.
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restrictions → suspect → countries
Drugs that would otherwise have moved on stayed in Fiji, seeding this domestic market which didn't really exist before."
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which → move → market
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.
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Fijians → suggest → meth
"The communities I work with report children as young as 9 using injectable drugs," he says.
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he → work → drugs
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.
uncertain
risk → accord → it
This includes the so-called "bluetoothing" or "hotspotting" practice where one person injects the drug and then another person injects their blood.
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person → include → blood
Bluetoothing is known to occur in settings of extreme poverty as a cheaper way of getting high.
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Bluetoothing → know → way
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.
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alcohol → believe → 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.
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he → say → bluetoothing
Unfortunately, bluetoothing has fueled the spread of HIV.
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bluetoothing → fuel → HIV
Reports suggest that on average, one infected person in Fiji will pass the virus on to 10 others.
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person → suggest → 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.
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Soqo → add → transmission
Fiji's HIV epidemic is also spreading in other ways, including risky sexual practices.
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epidemic → spread → 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.
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Soqo → know → 2025
Balak says that low condom use is encouraging the spread of HIV.
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use → say → 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.
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they → find → sex
Lal can attest to this — having contracted HIV himself in the summer of 2024 through unprotected sex with a male partner.
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Lal → attest → partner
"You let your guard down once, and boom, it happens," he says.
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he → let → guard
The surge in cases has led to an influx of foreign aid to support new HIV testing, prevention and treatment programs.
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surge → lead → 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.
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government → concern → 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.
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government → accord → treatment
One of the first priorities for Australian organizations working with Fiji is to make HIV testing available at all antenatal clinics.
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testing → work → clinics
In 2025, 59 babies were born with HIV.
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babies → bear → 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.
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Holwill → try → Infection
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.
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HIV → place → utero
Blocking new infections on a wider scale is far more challenging.
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Blocking → block → scale
…and 37 more, not listed.
The Aporia
