DESPITE major progress achieved over the years in fighting the Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome (HIV/AIDS), recent trends suggest a worrying resurgence of the epidemic in parts of the Western Pacific Region, the World Health Organisation (WHO) says.

The latest shocking records have forced regional health leaders and experts to gather at a special event during the Seventy-sixth Session of the WHO Regional Committee for the Western Pacific (RCM76) in Nadi, Fiji, this week in an effort to address the growing link between HIV and drug use.

This comes at a time when new HIV diagnoses in Fiji have grown astronomically over the last five years, with many more undetected cases.

In fact, recently, Fiji has become the hotspot of one of the world’s fastest growing HIV epidemics.

The culprit is blood sharing, driven by unsafe sex and by an increase in dangerous drug use, as methamphetamine is trafficked through Fiji’s porous maritime borders, on the way to neighbouring Australia and New Zealand.

According to WHO, many countries are seeing more ‘new HIV cases’, especially among high-risk groups like people who inject drugs. In 2023, for instance, the Pacific and Asia regions had between 6.1 million and 7.5 million people living with HIV, making it the second-largest epidemic in the world after sub-Saharan Africa.

Fiji declared an HIV outbreak in January, with the number of people living with HIV more than doubling in the last year, reaching around 5900 cases by 2024, an 11-fold increase since 2014.

This means Fiji has the second-fastest growing HIV epidemic in the Asia-Pacific region behind Papua New Guinea (PNG), which has long had high HIV infection rates.

Experts in the region are concerned. They say lack of accessible HIV testing and shortages of vital medical supplies, among other factors, mean many cases may go undiagnosed and untreated.

In an online article by the BBC, José Sousa-Santos, head of the Pacific Regional Security Hub at New Zealand’s University of Canterbury, says “a perfect storm is brewing” in Fiji.

“The concern is across all levels of society and government in regards to Fiji’s HIV crisis – not just what’s happening at the moment, but where it’s going to be in three years’ time and the lack of Fiji’s resources,” the BBC quotes Sousa-Santos saying.

“The support systems – the nursing, the ability to distribute or to access the drugs for treatment of HIV – just aren’t there.”

That’s what terrifies us, the people that work in the region: there is no way that Fiji can deal with this.”

Mr Sousa-Santos predicts that an “avalanche” of cases is still to come.

“What we’re seeing at the moment is the beginning of the avalanche, but you can’t stop it, because the infections are already happening now, or they’ve already happened — we’re just not going to be able to see them and people aren’t going to look to get tested for another two to three years,” he says.

“There’s nothing that we can do at the moment to stop the number of infections that have already happened over the past year, and that are happening now. That’s what’s really terrifying.”

Dr Jalal Mohammed, senior lecturer at the University of Canterbury and University of Fiji adjunct professor describes the HIV/AIDS epidemic in Fiji as ‘ravaging’, adding that its impacts are not only being felt on the ‘health of the population and its economic potential’ but also on its ‘social systems and structures’.

Fiji’s situation also impacts efforts to control diseases like tuberculosis (TB), given the fact that in 2024, it was estimated that over 58,000 new TB cases in the region were connected to HIV infections, challenging the progress made in managing TB.

This inter-linkages shows that Fiji’s ‘already fragile health system’ is inadequately equipped to deal with a surge in the epidemic.

For decades the Fiji’s health service has struggled to deliver basic health care, complicated by the ravages of the global pandemic COVID-19.

The Ministry of Health allocated over $600 million in the 2025-2026 financial year, up from $540 million. Of that amount, a $10 million investment has been set aside to expand HIV prevention, testing, and treatment services nationwide, with particular focus on reducing transmission, improving access to care, and strengthening community involvement.

This investment is highly welcomed but it is not enough to halt the spread of the virus.

“To halt the spread, targeted health promotion messages around safe sex, regular testing, drug use, risks of needle sharing, advocated through social and community structures are needed,” Dr Mohammed says.

“However, this is proving to be difficult due to the stigma that exists in a highly religious and conservative society. Combatting the stigma will be central to reducing the spread.

“Needle exchange centres are also needed. Pharmacies have clamped down on the sale of syringes, without prescriptions, under police pressure.

“However, a greater problem exists. ‘Bluetoothing’ (and chemsex too) has grown in popularity due to multiple people being able to chip in for a single hit to get high on.”

Note that chemsex’ and ‘bluetoothing’ are rife practices where a drug user withdraws their blood after a hit to share with another person who can share the hit.

Dr Sharon McLennan, senior research fellow at the School of Health, Victoria University of Wellington, NZ believes two key strategies could offer Fiji some hope.

“First, an inward-looking strategy. Pacific culture and connections to the vanua (land, and cultural, social and spiritual identity) are strong. Traditional leaders remain highly respected and can play a powerful role in reducing stigma and leading local solutions,” says Dr McLennan.

“Secondly, external collaboration is vital. Australia and New Zealand, as key markets in the regional drug trade, share responsibility for addressing its impacts. Ongoing and coordinated support for regional anti-narcotics initiatives is crucial, as is addressing domestic drug demand.

“Health sector support and funding for infrastructure, prevention programmes and harm reduction must also be sustained.”

Dr Huong Thi Giang Tran, Director of Programmes for Disease Control at WHO Western Pacific, also agrees that stigma, criminalisation of drug use, and weak support systems for harm reduction are contributing to the resurgence of the disease.

International support for Fiji’s fight against HIV/AIDS and drug trade is important and strategic, considering that the country is the hub of the Pacific and the most popular tourist destination for Kiwis and Aussies.

In an article originally published on The Conversation, Dr McLenan says Australia and NZ bear particular responsibility and face specific risks because their domestic drug markets have driven regional trafficking, fuelling Fiji’s meth crisis and the HIV outbreak.

“Australia and New Zealand are key stakeholders, and their domestic policies and support can significantly affect the outbreak’s trajectory, contribute to a unified Pacific response and protect regional public health”

While major scientific advancements have transformed HIV into a manageable chronic condition, significant social and economic barriers threaten to reverse progress.

The HIV surge will be costly for the country and the region. Governments cannot do it alone. Therefore, a multisectoral, rights-based, comprehensive and collaborative approach focusing on prevention, testing, treatment, and social support is needed. There is no other way!

Until we meet on this same page same time next week, stay blessed, stay healthy and stay safe!!