On a recent Friday night, Dr Kesaia Tuidraki's medical team parked its mobile clinic outside McDonald's in downtown Suva, Fiji, and grabbed any kid they could to be tested for HIV. Of the 97 people screened, mostly teenagers – some on their way to get a burger, others to buy drugs – one in six tested positive.
“Children are suffering, children are dying, and if that doesn't move you I don't know what will,†Tuidraki, country director of Medical Services Pacific, tells the Guardian.
Fijian authorities this month called a national health emergency to deal with surging HIV cases, with an estimated one in 60 adults now living with the virus. It comes as new infections surge, with 2,016 new cases diagnosed in 2025 – rising by 27% in a year, and representing a 12-fold increase since 2010, according to UNAids. In a close-knit island nation of about 930,000 people, an estimated 9,100 are now living with the virus.
But only a fraction of those are tested and access treatment, prompting the government to scale up its pandemic announcement – first made in February 2025 – and mobilise urgent measures to prevent its spread. Dr Jason Mitchell, the head of Fiji's HIV epidemic response, said it could take between five and 10 years to get a handle on the virus, and in the meantime he would expect numbers to rise.
Critics say moves to stem the spread of a disease that is being driven by cases in the young, with new diagnoses highest in those aged between 15 and 34, has been too slow. The crisis is complex and inextricably linked to the drug epidemic – more than 42% of new cases in 2025 were due to sharing contaminated needles or equipment.
Health advocates and social workers say primary school-age children are among those injecting themselves and friends are using the same contaminated needle, a problem raised by advocates as far back as 2019.
“I know these young boys, they ask me for syringes,†injecting drug user Rochelle*, who is living with HIV, tells the Guardian. “Whenever I have them I give them out. Someone has to give them, they're already accessing the drugs.â€
Rochelle, 38, says she tries to tell the boys not to share. Sometimes the kids listen – but not always.
Under current law, giving out syringes is technically considered aiding and abetting drug use. A concern among some politicians and medical professionals is that providing needles would encourage drug use – despite evidence from UNAids that this is not the case –and advocates are urging the government to let them distribute thousands of needles and syringes sitting untouched in a Suva warehouse.
“It's really sad, honestly. We can't wait any more, there are boxes and boxes already here,†Tuidraki says.
Mitchell says he expects a change to the HIV Act to be passed within the next two weeks, allowing public health workers to distribute needles. He adds that the government has been “cautious†in announcing the emergency, which his unit had been asking for since June.
Those leading the response say increased powers arising from the emergency declaration will help to quell the rapid spread of HIV, including to vulnerable populations like mothers and babies, at an estimated extra cost of $23m FJD (US$10.2m) a year.
“The immediate crisis right now is the spread of HIV, which is why the needle and syringe programme is critical,†UNAids, the UN agency that fights HIV and Aids, regional director Eamonn Murphy said.
‘People are scared'
The epidemic is complex but heavily linked to methamphetamine use. Fiji is a drug-running hub in the Pacific for methamphetamine bound for Australian and New Zealand markets, but use escalated during Covid when borders were closed and it began circulating domestically.
While Fijians want the crisis addressed, there has also been a backlash. Only 39% of those living with HIV in Fiji know their status, according to UNAids, and some of those spoken to by the Guardian continued to live in denial or refuse testing.
“There are people blaming the [queer] community, blaming women as irresponsible people, there's a lot of cyberbullying. Minorities are being attacked online,†Mark Shaheel Lal, an advocate who lives with HIV, says. “Now it's more like a scandal and people are scared.â€
UNAids is also concerned about the spread of the virus to the Pacific, with rising cases seen in Solomon Islands and Papua New Guinea. In November, Australia's minister for foreign affairs, Penny Wong, announced A$48m for Pacific countries to fight HIV/Aids, while New Zealand committed NZ$4.2m to Fiji in July.
The introduction of PreP – or pre-exposure prophylaxis – an HIV prevention drug, would be a “gamechanger,†says Mitchell, who adds that one injection could be offered every six months for those at higher risk.
It would be especially important for women who are not able to push for safe sex practices with partners. Two in every 100 pregnant women now have HIV. “You can't hide a bottle of pills, but you can get an injection,†says Michell.
For now, women are already being offered three HIV tests during pregnancy and sexual reproductive hubs are operating at the three main hospitals.
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“There's no miracles in the HIV response, it does not happen overnight. Unfortunately people are thinking this is like Covid, it's very much not,†Mitchell says.
His team plans to open new clinics, integrate testing and treatment into GP services, work on harm reduction, and hire at least 100 more staff. He says that the increase in cases means more people are getting tested, which is a positive.
“Burnout is a major concern – we didn't just start working yesterday, we've been working for 21 months. It's difficult, and the difficulty is that all of it is preventable. It should not be happening.â€
But in many areas, including rural localities, access to treatment continues to lag. Drug Free World Fiji founder and campaigner Kalesi Volatabu is still haunted by the 15-year-old girl she met when she started pushing for a safe needle programme six years ago. A drug mule who smuggled methamphetamine to New Zealand and Australia, she had names for the three main veins on the back of her hand; breakfast, lunch, and dinner.
“We had no idea of the severity, of the depth of the drug trade in this country, of the HIV crisis. Even I was naive, at the beginning, and everything was unreported for the longest time. We failed to act then – will we now?â€
*Name has been changed
