A Pacific Voice in the Global Healthcare Conversations Podcast - My Reflections
Updated: Oct 9
On the 1st of October 2026, I joined the Global Healthcare Conversation, a podcast by the University of North Florida, to talk about HIV across the globe and, in particular, the current epidemic in Fiji. Hosted by Dr Shyam Paryani of the University of North Florida and joined by Dr Minali Varsandani of Griffith University, we sat down to discuss why, 45 years into the HIV epidemic, cases are rising in some parts of the world, such as Fiji.
In the podcast, we discussed how the United States, Australia and New Zealand have brought HIV under control. New Zealand recorded 80 new cases in 2025. Fiji, on the other hand, recorded 2016 new cases in 2025. An estimated 9,100 people live with HIV in Fiji. With an estimated population of 940,000, that’s roughly 1.6% of the adult (15-49) population.
So how did Fiji get here? Fiji is on the drug superhighway, and as a result, methamphetamine has entered the country over the past decade, and injecting drug use has grown with it. Fiji has also seen increased needle sharing, a practice locally known as ‘bluetoothing’, where, due to the costs, hits are shared. This has driven most new infections, particularly among young men aged 20 to 24, who account for two-thirds of new cases. But the epidemic is now moving into a ‘generalised epidemic’ phase. Sexual transmission is rising, as is mother-to-child transmission. Shockingly, one child is born each week with the virus, and one dies each month (0-4 year olds). Most countries have eliminated this pathway.
We discussed the role that Governments have played in managing HIV across the world. Fiji declared an HIV outbreak in January 2025 and, in September 2026, declared it a national emergency. This is an important, critical step in the response: it cuts through red tape, makes it a whole-of-government effort rather than a Ministry of Health problem, and brings civil society partners and donors together with the government to respond under one coordinated structure. At the time of recording, Fiji was about to pass a bill through its parliament to amend the HIV Act to allow safe needle exchanges, something we have seen to reduce transmission in Australia, the United States and New Zealand among drug users.
We also spoke at length about stigma. We have seen that this has been a huge factor globally in whether interventions succeed. In Fiji, stigma has surfaced in several forms. A needle and syringe exchange programme has been hard to introduce because many believe that providing clean needles promotes drug use. Fiji is also a deeply religious society, and social media commentary reveals that HIV is framed as a punishment from God. A lack of privacy in health facilities has furthered this stigma. In small, close-knit communities, when people overhear conversations and diagnoses, this further leads to stigma. So, while antiretroviral therapy, PrEP, and PEP are all free, privacy concerns can still affect access. Most Fijians also live in extended, multigenerational households. So, a bottle of medication can raise questions, and some people may avoid treatment as a means to avoid the questions.
Misinformation is also having an impact. Social media, popular in Fiji, reveals a growing rhetoric around COVID vaccines leading to increased HIV cases. Misinformation also affects treatment, and herbal medicines and home cures have been widely shared online. This has impacts on those with HIV accessing and adhering to treatment.
We also discussed what it will take to turn the epidemic around. I stressed that no single intervention or measure can turn this around. We need a coordinated, multi-pronged effort to tackle the crisis. I mentioned four key short-term measures.
Resources: Global HIV funding is decreasing, and Fiji and many other low-resource countries rely on donor funding to combat HIV. Fiji’s neighbours, such as Australia and New Zealand, have a role to play, as does the wider region, including Pacific-rim countries such as the United States and China. They all have aid programmes that could work with the Fijian Ministry of Health to turn this crisis around.
Shared Knowledge: Australia, New Zealand and the United States have had success in reducing HIV transmission. Australia and New Zealand have reached the WHO 95-95-95 treatment cascade targets, while the United States is close to achieving this. These countries have technical knowledge and capacity that Fiji could share and adapt to its context to reduce transmission and increase testing and treatment rates.
Reinvestment in Public Health: Fiji has a health infrastructure across 333 islands that public health professionals (predominantly public health nurses) can use for health promotion, sexual health education, and stigma- and misinformation-reduction activities. However, chronic underinvestment undermines the ability to use this infrastructure for health promotion and sexual health education.
Innovation and newer tools: Stigma and misinformation, along with limited resources, mean that Fiji must be innovative with its interventions. I mentioned in the podcast that newer medications, such as the twice-yearly Lenacapavir injection, can help mitigate issues such as questions at home about medications. As Fiji fights the epidemic, it must look at innovative solutions to both the increased use of methamphetamine and increased HIV rates in the country.
What is clear is that interventions are needed. Without interventions, the prevalence rate could reach 4%, in the next three to five years. This could even be more. However, Fiji stands a chance to reduce the increase to 2.5% to 3% in the next three to five years. The emergency declaration is a positive step, but a declaration alone does not reduce infections. It needs strategy and resources to back it up.
I closed with the thought I most want people to take away. Behind 2,016 new cases are 2,016 people and their families. Much of this is preventable. HIV is not the death sentence it was four decades ago. It is a manageable condition. Concrete actions are needed, and Fiji needs support to implement them.
My thanks to Dr Paryani and Dr Vasandani for the invitation and the opportunity to further the conversation on HIV in Fiji. The episode will be available on the Global Healthcare Conversations page.
Watch the podcast below:
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