The world’s fastest growing HIV epidemic is linked to crystal meth: NPR

Best known as a tropical paradise and honeymoon destination, the island nation of Fiji now has the unfortunate distinction of facing two intertwined epidemics: HIV and addiction to crystal meth.

With HIV cases increasing 12-fold between 2010 and 2025, in mid-September, the Fijian government declared a national emergency. Estimates are that there are up to 9,000 cases; The country’s health minister announced that 1 in 60 adults are now living with HIV.

At the July AIDS 2026 conference in Rio, Jason Mitchell, a public health specialist who leads Fiji’s HIV response, described it as the fastest growing HIV epidemic in the world, noting that two-thirds of cases are in those aged 20-34. “Our young, active, productive population is currently being infected with HIV, and unless we find solutions quickly, this will continue to get worse,” he says.

A key cause is another parallel epidemic – the rampant use of crystal meth among the nation’s youth, who frequently inject it. This led to transmission through shared needles.

“Two of my best friends died,” says Mark Lal, a 25-year-old HIV activist from Fiji’s capital, Suva. “The majority of my friends, they got HIV from crystal meth.”

The meth factor

Crystal meth has long been available to some degree in Fiji – the islands are a known transit hub for the drug between South America and the eventual destinations of Australia and New Zealand. But since COVID, the use of meth has increased, something that Fiji’s HIV experts attribute to the lethal combination of rising unemployment and increasingly accessible drugs.

“COVID has been a difficult time for Fijians,” says Sailosi Soqo, a doctor who works on the national HIV response team. “Most lost their jobs, got reduced hours or were stuck at home. At the same time, we suspect that the travel restrictions, along with increased border security, have reduced the movement of narcotics to their target countries. Drugs that would otherwise have flown away have remained in Fiji, seeding this internal market that didn’t really exist before.”

Soqo suggests that spiraling unemployment, combined with deteriorating mental health due to the effects of the lockdown, has led to younger Fijians turning to meth, even preteens.

“The communities I work with report children as young as 9 using injectable drugs,” he says.

According to Dashika Balak, a doctor who leads Fiji’s national HIV treatment, care and support efforts, the risk of HIV transmission has also been exacerbated by a national shift from smoking meth to injecting. This includes the so-called “bluetoothing” or “hotspotting” practice, where one person injects the drug and then another person injects their blood.

Bluetoothing is known in settings of extreme poverty as a cheaper way to get high. But Mitchell believes its popularity in Fiji is partly because sharing of all things is part of the national culture – both alcohol and the ceremonial drink kava are consumed via a communal glass or bowl – and partly because of a scarcity of needles. Soqo says law enforcement in Fiji has cracked down on needle availability in an attempt to combat meth use, something he believes inadvertently encouraged Bluetooth.

Unfortunately, Bluetooth has fueled the spread of HIV. Reports suggest that on average, one infected person in Fiji passes the virus on to 10 others. “You add the existing culture in Fiji of sharing things, plus the limited access to clean injection equipment, and you get the perfect storm for HIV transmission,” says Soqo.

Fiji’s HIV epidemic is also spreading in other ways, including risky sexual practices. “What we know is that sexual intercourse, as a transmission route, will account for approximately 50% of new HIV cases by 2025,” says Soqo.

Balak says low condom use encourages the spread of HIV. A 2021 survey found that among 15- to 49-year-olds with multiple sexual partners in the past year, only 24% of men and 9% of women used a condom the last time they had sex. Lal can confirm this – he himself contracted HIV in the summer of 2024 through unprotected sex with a male partner. “You let your guard down once, and boom, it happens,” he says.

Prevention of a permanent epidemic

The surge of cases has led to an influx of foreign aid to support new HIV testing, prevention and treatment programs. Concerned about rising rates of infections and the potential for the epidemic to spread further across the Pacific, the Australian government announced a new $48 million funding package in August. According to a statement to NPR, the government is committed to supporting Fiji’s HIV response to prevent new infections, improve early diagnosis and expand access to treatment.

One of the first priorities for Australian organizations working with Fiji is to make HIV testing available in all antenatal clinics. In 2025, 59 babies will be born with HIV.

“We’re trying to get a reliable rollout of these tests so that every pregnant woman anywhere in the country is tested for HIV,” says Storm Holwill, a public health doctor who works at Melbourne’s Peter Doherty Institute of Infection and Immunity.

Anyone who is HIV-positive would then be put on viral-suppressing drugs known as antiretrovirals to limit the chances of HIV being passed on in utero.

Blocking new infections on a wider scale is much more challenging. Meth use is most prevalent among some of the poorest and most vulnerable populations in Fiji, many of whom have no fixed address. This makes it difficult for medical professionals to test and prescribe treatments.

Balak explains that while anywhere between 9,100 and 12,000 people in Fiji are thought to have HIV, only 5,676 of these cases have been officially diagnosed. Even fewer take regular antiretrovirals to keep their condition under control.

“Some stop treatment, and some cannot be reached because their contact details are incomplete,” she says.

This means that while Australia’s aid provides Fiji with ample access to drugs such as PrEP pills to block HIV infections, getting these drugs to the right people is not easy.

“We just introduced PrEP about two months ago,” Mitchell says. “Uptake has been very slow, and at the same time, antiretroviral treatment is also freely available, but it’s currently sitting on the shelves.”

Lal argues that one of the biggest problems is a lack of awareness. He says many people in Fiji have never heard of these medicines. Even for those who have it, it requires a long journey to one of three dedicated clinical centres, either in the cities of Suva and Lautoka or in the town of Labasa.

With Fiji’s population spread across more than 100 islands, Lal says such a journey is likely to deter many people from seeking care. “If they know the medicines are far away, they don’t even want to approach them,” he says. “In a country like ours, where religion is big, people would – instead of going – pray and believe that God will heal them.”

Mobile clinics and clean needles

To improve access to PrEP and antiretrovirals, Balak and her colleagues began creating dedicated HIV response teams in 21 locations across the country. “They will soon be able to order their own antiretrovirals [and] spend alone and fully manage their patients,” she says.

To track more people living with HIV, the team is also recruiting and training peer support workers – including some existing meth users who are HIV positive. Balak says she hopes this could be a way to connect more people most at risk of contracting HIV with medical teams.

Methamphetamine use remains a tense issue, and some of the proposed schemes to address the spread of HIV have failed with law enforcement.

To break the chains of infections from contaminated needles, Soqo proposed to supply thousands of sterile needles and syringes to communities of methamphetamine users. However, Soqo says the government is blocking the plan. “The Director of Public Prosecutions told us: ‘If you hand these out, we will arrest you, and we will charge you with aiding and abetting the attack,'” he says. “As a result, I now have a warehouse full of needles and syringes, just gathering dust.” The Fiji government did not respond to a request for comment from NPR.

However, there is more optimism that other approaches could make a significant difference. Fiji is set to receive supplies of the drug Lenacapavir, an injectable form of PrEP that offers close to 100% protection against HIV to people at risk of infection due to sexual behavior or drug use. Because this new preventative drug only needs to be administered twice a year, Mitchell believes it will be easier to convince people to use it compared to daily pills.

To prevent women from getting HIV from their partners while pregnant, antenatal clinics hope to offer vaginal rings that slowly release a protective antiretroviral drug over the course of a month.

Such innovations are badly needed. Projections suggest that if the epidemic continues at its current pace, 25,000 people in Fiji will be living with HIV by 2029, numbers that Soqo says will push Fiji’s fragile health system to the brink of collapse.

“Time is not on our side,” says Soqo. “With the current numbers, we are already struggling. All our main hospitals are overcrowded and have chronic problems with staff shortages. Our tuberculosis hospitals and primary health facilities tell us they are seeing an increase in advanced HIV cases and are overwhelmed. Imagine how things will be in three years. There is an urgent need for more action now.”

David Cox is a freelance health journalist who has written for publications around the world, including NPR, The New York Times, Wired in the The Guardian. He has a Ph.D. in neuroscience.

For stories about life in our changing world, subscribe to NPR’s Global Health Newsletter.