A new rapid assessment in Fiji has revealed that unsafe injecting practices, caused by the lack of harm reduction services such as needle and syringe programmes (NSPs), are significantly increasing the risk of HIV transmission among people who inject drugs. This comes amid one of the fastest-growing HIV epidemics in the Pacific island nation, highlighting the urgent need for targeted public health interventions.
The assessment was commissioned by the World Health Organization’s Division of Pacific Technical Support and the United Nations Development Programme at the request of Fiji’s Ministry of Health and Medical Services. Conducted by the Kirby Institute, Fiji National University, and the Australian Injecting and Illicit Drug Users League, and funded by The Global Fund, the study examined drug use, risk behaviours, health-seeking behaviours, and service delivery gaps to inform Fiji’s HIV response.
Researchers combined a desk review of quantitative data with interviews of 56 people who inject drugs and five talanoas—traditional inclusive dialogue sessions—with 50 key informants from civil society, healthcare, government, law enforcement, and faith-based organizations. The study highlighted the growing HIV burden in Fiji, where 1,583 new cases were reported in 2024 and 1,226 cases in the first half of 2025. UNAIDS estimates suggest the number of people living with HIV has risen from around 2,000 in 2020 to 6,100 in 2024, with nearly half of those starting treatment being people who inject drugs.
All participants reported reusing needles or syringes due to limited access to sterile equipment, putting them at high risk of HIV, hepatitis, and other injection-related infections. Methamphetamine was the most commonly injected drug, and many first-time users were exposed to potentially contaminated equipment. Low HIV awareness and difficulty accessing testing and treatment further compound the risk for these populations.
The assessment strongly recommends implementing NSPs to provide sterile needles and syringes, a proven public health and human rights intervention. Minister for Health Dr. Atonio Lalabalavu emphasized the urgent introduction of these programmes as part of Fiji’s public health response, supported by international partners. WHO’s Dr. Mark Jacobs underscored that evidence-based interventions like NSPs prevent infections, save lives, and strengthen community health.
Professor Lisa Maher of the Kirby Institute highlighted that the study provides critical baseline data for Fiji’s HIV prevention and harm reduction strategies, including training 15 people who inject drugs as peer educators to reach their communities. UNDP Resident Representative Munkhtuya Altangerel stressed that Fiji’s HIV epidemic is a pressing development and human rights issue requiring urgent, decisive action to expand harm reduction, testing, and treatment services.
In response, Fiji’s Ministry of Health, together with WHO, UNDP, and partners, is implementing a comprehensive HIV Surge Strategy (2024–2027) and HIV Outbreak Response Plan. The strategy aims to expand HIV testing and treatment, strengthen outreach to key populations, introduce harm reduction measures like NSPs, and ensure stigma-free, confidential care. Without swift intervention, the number of people living with HIV in Fiji is projected to rise sharply, with severe health and social consequences.
