Fiji has declared a national crisis amid an extraordinary rise of H.I.V. cases, with health officials raising the alarm about an epidemic that has emerged alongside an increase in injectable drug use.
Fiji, a Pacific island nation of fewer than one million people, recorded more than 2,000 new H.I.V. cases in 2025 — 16 times as many as in 2019, the government said in an official statement on Tuesday. One in 60 adults on the archipelago is living with the virus that causes AIDS, the government estimated.
UNAIDS, a United Nations program, said in a statement on Wednesday that it was “one of the sharpest increases in new H.I.V. infections globally.”
Winnie Byanyima, the executive director of UNAIDS, added that Fiji’s epidemic was “a stark reminder to the world that AIDS is not over.”
The outbreak is not limited to particular areas or populations, health officials warned. And because the nation serves as a regional hub for business, tourism and transport, the surge in cases could affect other countries in the South Pacific if left unchecked.
That interconnectedness may have contributed to the soaring rates of infection, said Eamonn Murphy, the director of regional support teams in the Asia Pacific region, Central Asia and Eastern Europe for UNAIDS.
An influx of drugs on the islands during the coronavirus pandemic added “fuel on the flame” to a longstanding, but low-level, H.I.V. presence in Fiji, Mr. Murphy said.
The country is a key example in a growing trend of Pacific island nations “caught in the middle of illicit smuggling routes,” according to a 2024 U.N. report. As substances like methamphetamine and cocaine pass through Fiji and other island nations on their way to Australia and New Zealand, the report said, those nations have emerged as drug markets, not just way stations.
Fiji is also one of several global hot spots where a dangerous trend called “bluetoothing,” in which people inject themselves with the blood of other drug users to get a cheap high, is contributing to spikes in H.I.V. rates.
Health officials say they believe that drug use is a key driver of Fiji’s epidemic. A December report by the World Health Organization and United Nations Development Program found that nearly half of the H.I.V. patients with available information about their exposure had injected drugs, primarily crystal methamphetamine.
“Fiji was off the map in terms of H.I.V.,” Mr. Murphy said. But in recent years, the virus has spread throughout the country, heavily affecting young men but also raising mortality rates among children and babies born to infected women.
In its statement on Tuesday, the government said that 59 infants were born with H.I.V. in 2025, with 18 of them dying before their first birthday.
Fiji’s government has ramped up testing and treatment efforts since January 2025, when the nation declared an H.I.V. outbreak. But “an outbreak-level response is no longer sufficient,” Dr. Atonio Lalabalavu, the nation’s health minister, said in a video statement posted on Tuesday.
Fiji pledged a “whole-of-government response,” including expanded access to free testing, prevention services and treatment, as well as harm-reduction measures such as programs that allow people who inject drugs to exchange used needles for clean ones.
Mr. Murphy praised the government’s efforts, but said community leaders and the religious authorities would have to help combat the stigma around drug use and misunderstandings about H.I.V. and its treatments.
“They really need to move fast,” he said.
