Fiji has declared a national health emergency in response to one of the world’s fastest-growing HIV crises, as a sharp rise in infections coincides with increasing methamphetamine use. The government estimates that one in every 60 adults is now living with HIV, while one in 50 pregnant women has the virus. The declaration marks a shift from routine containment to a coordinated national response aimed at expanding testing, treatment and harm reduction.
Government moves from outbreak response to emergency action
Dr Ratu Atonio Lalabalavu, Fiji’s health and medical services minister, said the scale of the crisis demanded measures beyond an outbreak-level response. Following a cabinet decision on 9 September, he formally announced the emergency on social media on Wednesday.
“Today I am formally declaring a national health emergency in Fiji,” he said. “This decision recognises the seriousness of the epidemic and the urgent coordinated response our country now needs.”
The figures illustrate how rapidly the situation has deteriorated. Five years ago, officials estimated that one in 167 adults was living with HIV; the current estimate is one in 60. Fiji recorded 2,060 new HIV diagnoses in 2025, while the prevalence among pregnant women has reached what the government describes as one in 50.
For a Pacific nation of fewer than one million people, those proportions represent an exceptional public health burden. The emergency status is intended to bring greater urgency and coordination to services that have struggled to keep pace with transmission.
Methamphetamine and unsafe injecting fuel transmission
Fiji’s position as a hub for drug trafficking has intersected with rising local methamphetamine consumption, creating conditions in which HIV can spread more quickly. Unsafe injecting and limited access to sterile needles have compounded the problem, while low levels of health awareness, cultural stigma and insufficient testing and treatment have allowed infections to go undetected.
Among cases where the mode of transmission is known, more than half are linked to sexual transmission and over 42% to injecting drug use, according to UNAIDS. The data points to a crisis with several interconnected drivers rather than a single route of transmission.
UNAIDS estimates that new HIV infections in Fiji increased twelvefold between 2010 and 2025, placing the country among those experiencing the steepest rises globally. The figures also expose the consequences of delayed prevention: once transmission becomes established across sexual networks and among people who inject drugs, reversing it requires far more than awareness campaigns alone.
Most people with HIV remain outside care
The most urgent gap is the number of people who do not know they have HIV or are not receiving treatment. Of an estimated 9,100 people living with the virus in Fiji in 2025, only 39% were aware of their status and just 22% were accessing antiretroviral treatment, according to the UN agency.
Winnie Byanyima, the executive director of UNAIDS, said Fiji’s emergency was “a stark reminder to the world that AIDS is not over”. She added: “HIV epidemics can change quickly, and countries need health and community systems that are ready to respond urgently. Fiji has recognised the urgency of the moment and is stepping up its response.”
UNAIDS welcomed plans for a needle and syringe programme, with legislative amendments expected to be put before parliament. It also backed efforts to broaden prevention, testing and access to treatment. Those measures will be central to determining whether the emergency declaration produces a durable reduction in transmission rather than a temporary mobilisation of government resources.
Why it Matters
Fiji’s emergency demonstrates how swiftly an HIV epidemic can intensify when drug use, stigma and weaknesses in basic healthcare reinforce one another. The consequences extend beyond infection statistics: untreated HIV threatens maternal and child health, places greater strain on hospitals and deepens inequalities in communities already facing barriers to care. For governments everywhere, including those in Europe, the lesson is clear. HIV cannot be treated as a problem confined to a single clinic, border post or social group; effective control depends on combining public health, harm reduction and accessible treatment before a rising curve becomes an emergency.
