While Australia is considered to be on track to virtually eliminate HIV transmission by 2030, one of our regional neighbours is confronting a rapidly accelerating HIV crisis that health experts warn could overwhelm its already stretched health system.
Fiji is facing one of the fastest-growing HIV epidemics in the world, with over 3,000 new infections expected this year alone. A decade-long surge in infections pushed the small island nation to declare a national HIV outbreak in January.
The Albanese Government announced a $48 million investment into the Pacific response to HIV on Thursday, said to protect the "shared health security" of the region — that includes Fiji — through technical assistance, disease surveillance and co-investment in public health responses.
The joint United Nations HIV/AIDS program (UNAIDS) estimates the number of people living with HIV in Fiji has risen from fewer than 500 in 2014 to 5,900 a decade later — an elevenfold increase.
Only 36 per cent are aware of their status and just 24 per cent are on treatment, according to UNAIDS data.
During the same period, overall HIV diagnoses in Australia decreased by 33 per cent.
Separately, Fiji's Ministry of Health logged 552 new cases in the first half of 2024 alone, most of which were among people under 40. It was a 33 per cent increase on the previous year.
Preliminary data shows injecting drug use accounts for half of newly diagnosed patients receiving antiretroviral therapy.
Foreign Minister Penny Wong said Australia's support would reinforce Pacific-led health responses, including community-based programs that have struggled to keep pace with the scale of Fiji's outbreak.
"Australia is continuing to work with our Pacific partners to reduce HIV transmission and support people living with HIV," she said in a statement on Thursday.
The statement warned that COVID-19 was "an important reminder in recent years that communicable diseases, such as HIV, cost lives and ignore borders".
Australia's HIV leadership
Dash Heath-Paynter, chief executive of Health Equity Matters, a national federation of Australian HIV and LGBTIQA+ organisations, said Australia's investment had landed at a critical point for Fiji and its neighbours.
"Countries in the Pacific — particularly Fiji — are seeing a significant, fast-moving and very troubling outbreak of HIV which is making the region one of the most challenging areas in the global HIV epidemic," he said on Friday.
"The US, which has withdrawn a lot of aid across the world has never really invested in this region, so it really is for Australia — and probably a lesser extent, New Zealand — to demonstrate leadership here," he said, adding that Australia had "a lot of excellence in terms of addressing HIV domestically".
Professor Brendan Crabb, chair of Pacific Friends of Global Health, praised what he called Australia's "timely intervention" to address an outbreak that "threatens not just Fiji but the entire Pacific region".
"Infectious disease outbreaks require constant vigilance and sustained investment — the moment we look away, they accelerate," he said.
"Australia's dual commitment to both regional crisis response and The Global Fund shows strategic thinking about health security."
The Global Fund raises and invests money to fight AIDS, tuberculosis and malaria in low- and middle-income countries.
How Fiji's epidemic exploded
Behind Fiji's escalating outbreak is a convergence of social, geographic and behavioural pressures that have intensified over the past five years.
As the Pacific's role in regional drug trafficking has grown, so too has injecting drug use — and with it, new practices that dramatically increase transmission risk.
One of the most dangerous is "bluetoothing" or "hotspotting" — a form of blood-sharing in which users pass drug-laced blood between multiple people using a single syringe.
Heath-Paynter said the practice has fuelled a severe outbreak among injecting drug users.
"Fiji is positioned in the middle of the Pacific; a lot of illicit drugs seem to come through," he said.
"You've got an under-resourced clinical workforce, limited health literacy around the risks of sharing injecting equipment, and a big supply of drugs. That creates an environment where there is a very easy transmission pathway for HIV."
Limited surveillance, under-reporting
Sexual transmission — including among gay and bisexual men and likely among sex workers — is also contributing, but surveillance gaps make the true scale unclear.
"Australia has very robust HIV surveillance measures and interventions in place which means that we are able to really have a sense of where our own epidemic is at in real time," Heath-Paynter said.
"In countries like Fiji, there is very limited research — very limited surveillance capability — which means the reported figures are probably a significant under-reporting.
"There are many infections happening on a daily basis and what that means is that there would be many people acquiring or seroconverting (the process by which HIV antibodies first become detectable) that are going to be diagnosed late."
He said weak sex education amplifies these risks, especially because governments in the region often lack experience working with, and targeting messaging to, key populations.
With uneven health infrastructure across Fiji's hundreds of islands, many people still depend on intermittent outreach or long travel to reach testing sites.
Crabb said these overlapping challenges — stigma, scattered populations, disrupted services and limited surveillance — may compound and further spread the crisis.
"Without comprehensive harm reduction programs, this outbreak will overwhelm health systems across the Pacific."
Share
