Fiji's HIV crisis explodes as infections surge at one of the world's fastest rates

Fiji diagnosed more people with HIV last year than in any year since the virus was first found there in 1989. More than a third of everyone ever diagnosed in the country was found in that single year.

The figures come from the Fiji HIV Surveillance Report 2025, published this year by the country's Ministry of Health and Medical Services.

Fiji is a Pacific island nation of fewer than a million people, spread across more than 300 islands, and until recently it had one of the smallest HIV problems in the world.

That is no longer true, and the report sets out in detail how quickly the picture changed.

From forty a year to two thousand

For most of the epidemic's first thirty years, Fiji recorded between ten and forty new cases annually.

The rise began slowly, reaching 131 cases in 2018, and then it accelerated sharply. There were 245 diagnoses in 2022, 415 in 2023, and 1,583 in 2024, before the total reached 2,016 last year.

The cumulative count tells the same story from another angle.

From 1989 to 2021, Fiji recorded 1,662 cases in total. By the end of 2025 that figure stood at 5,676, which means most people ever diagnosed in the country were diagnosed in the last four years.

Needles, and a programme that does not exist

The ministry attributes the rise to several things happening at once.

Injecting drug use has spread, with needles and syringes shared between users, and Fiji still has no harm reduction programme to supply clean equipment.

The report also notes that police pressure on pharmacies has reduced the number of needles available through retail shops, which pushed sharing further.

Alongside that, the report points to widespread untreated sexually transmitted infections, which make it easier for HIV to pass during sex, and to a rise in infections passed from mothers to babies.

Dr Jason Mitchell, who chairs Fiji's National HIV Outbreak and Cluster Response Taskforce and oversaw the report, told a media briefing at the International AIDS Conference in Rio de Janeiro, Brazil, on 30 July 2026 that drug use had collided with local custom.

"We typically share everything," he said, describing how kava, a traditional root drink, is passed around a single bowl and cup, and how that habit carried over first into alcohol and then into injecting.

Of the 2,016 cases last year, the route of infection is recorded for only 849 people, because that information is collected once someone reaches a clinic and most had not.

Among those with a known route, injecting drug use was the single largest category at 362 cases, while sex between men and women accounted for 286 and sex between men for 144.

The epidemic is young

Two in three of the people diagnosed last year were aged between 20 and 34, and the single largest group was people aged 20 to 24, with 646 cases.

Another 257 were teenagers aged 15 to 19, a group that recorded just six cases in 2022.

Men made up 65.7 percent of diagnoses, but that gap is closing rather than widening.

In 2024 men were 70.2 percent of cases, and back in 2019 diagnoses were split almost evenly between men and women.

The share of cases among indigenous iTaukei Fijians was 93.9 percent, though the ministry cautions that this reflects who is coming forward for testing and should not be read as a difference in risk between communities.

The geography is narrow. The Central Division, which contains the capital Suva, accounted for 1,359 cases, just over two thirds of the national total.

Sixty-seven children

Children under 15 accounted for 67 of last year's diagnoses, and 56 of those were children under the age of five, an age at which infection almost always means the virus was passed during pregnancy, birth or breastfeeding. Seventeen children under 15 died of HIV-related causes during the year, sixteen of them under five.

Found, and then lost

The hardest number in the report is not the case count. Of the 2,016 people diagnosed in 2025, 845 were never enrolled in care at all, and a further 128 were enrolled but had not started treatment.

That is an improvement on the previous year, when 47.6 percent of newly diagnosed people went unenrolled, against 41.9 percent last year, and treatment coverage among the newly diagnosed rose from 44.9 to 48.4 percent.

But the wider picture is harder. Across the whole national register of 3,535 people living with HIV, 1,979 were on treatment and only 288 had a test on record confirming the virus was suppressed.

Set against the UNAIDS estimate of roughly 8,900 people living with HIV in Fiji, the ministry puts national performance at about 40 percent diagnosed, 22 percent on treatment and 5 percent with confirmed suppression. The global targets are 95, 95 and 95.

Deaths, and what the data cannot see

Fiji recorded 117 HIV-related deaths in 2025, slightly below the 126 recorded in 2024, though the ministry warns against reading that as improvement, since late reporting means the 2025 figure is likely incomplete.

Deaths have climbed steadily from 25 in 2021.

Sixty-seven of those who died had been diagnosed only that same year.

Nearly nine in ten had been diagnosed at some point since 2023, which points to people reaching a clinic when they are already seriously ill.

The report cannot say how ill, for a plain reason.

Doctors measure immune damage with a CD4 test, and the machine at Colonial War Memorial Hospital in Suva was out of action from March to August last year, while the machine at Labasa Hospital in the north broke in February and was still not working when the data was analysed.

Only 333 of the 2,016 people diagnosed have a CD4 result recorded at all. Of those who do, more than a third were already at the advanced stage of the disease.

A Pacific problem, not a Fijian one

Money and medicine are arriving.

India handed over more than three tonnes of antiretroviral drugs in November 2025, its largest such shipment to Fiji.

Australia funds the technical work behind the surveillance report through the Kirby Institute in Sydney, and New Zealand is also assisting. Fiji holds a small Global Fund grant, but it is due to transition off that money within three years.

What is still missing is the needle and syringe programme.

Mark Shaheel Lal, founder of Living Positive Fiji and one of the few Fijians to speak publicly about living with the virus, told the same Rio briefing that the programme "is something that really needs to be implemented, and it is not". Mitchell agreed it was the central gap, and warned that the epidemic now threatens other Pacific islands.

Testing is the part that is working. Community-based rapid testing quadrupled between 2024 and 2025, and more than 92,000 screening tests were done across the country.

The ministry's own conclusion is that finding people is no longer the binding constraint, and that without systems to start treatment quickly and keep people in care, a rising case count will keep translating into deaths.