Fiji scrambles to contain HIV outbreak driven by meth use and 'bluetoothing'

Mark Lall had already witnessed three friends die from AIDS before he was diagnosed with HIV. When he learned that his test result was positive, he knew very well what might happen next. "They started losing weight drastically, their organs failed," he said, "Their passing touched me a lot."

Since his diagnosis, Lall's experience has been different because he has received treatment to control the effects of HIV. But it has not been easy for the 23-year-old Fijian. "When I found out I was infected, I shut myself off, it felt like the ground cracked open, I fell in, and then it closed again," he said.

This situation is becoming increasingly common in Fiji. The country's rapid increase in HIV cases prompted the government to declare an outbreak in January of this year. While Fiji is working to control the increase in infections, the related data is alarming. The Fijian health authorities recorded more than 1,000 cases last year, three times as many as in 2023, and nine times as many as in 2019.

According to UN data, Fiji is the second-fastest-growing country for HIV in the Asia-Pacific region, second only to the Philippines. Moreover, it is believed that official data does not reflect the true scale of the epidemic, as many cases go undetected.

President of the Fiji Medical Association, Dr. Alipate Vakamocea, is shocked by the accelerated rate of infection and worried that the healthcare system cannot keep up. The health authorities say that half of the people with HIV in Fiji are not receiving treatment or cannot be contacted, making it more difficult to control the epidemic. Dr. Vakamocea said that doctors have long been trying to draw the government's attention to the epidemic. "They have been calling for action, but it seems that little progress has been made," he said.

The outbreak is closely related to Fiji's growing drug problem. The Ministry of Health says that about 50% of new cases are caused by intravenous drug use. As methamphetamine bound for Australia passes through the Pacific island nation, it flows into the local market. Methamphetamine use is spreading among Fijian adolescents and young adults, and media reports say that syringes containing methamphetamine sell for as little as 10 Fijian dollars (about $7 USD) on the streets of Suva.

The surge in drug addiction is overwhelming local medical services. Dr. Vakamocea said that Fiji's only psychiatric institution, St. Giles Psychiatric Hospital, is "filled with drug addicts seeking help," including elementary school students. He said that people as young as 13 years old are contracting HIV through intravenous drug use. The health authorities also warned that the shocking practice of "Bluetooth" is exacerbating the problem. This practice refers to drug users drawing their blood back into the syringe after injecting methamphetamine and then injecting it into others to share the high.

"When we consider not only HIV, but also other infectious diseases, this behavior is very dangerous because it injects one person's blood into another person's body," said Michelle O'Connor, head of the global division of ASHM, an organization of health workers summit. Dr. Vakamocea said that the wave of new cases caused by the increase in intravenous drug use in Fiji has confused the health authorities, who mainly focus on controlling the spread of HIV through sexual behavior. "When you delve into the data, you will find that this outbreak was caused by intravenous drug use," he said.

On a sunny morning in Suva, the capital of Fiji, a group of volunteers are distributing T-shirts printed with messages encouraging safe sex. They are preparing for a rally aimed at raising awareness of sexual health, which is part of a new national condom campaign launched by the Fijian Ministry of Health. In addition, there are plans to establish 63 condom distribution points. As the severity of the HIV epidemic becomes increasingly apparent, the campaign is one of the growing number of measures taken by the health authorities.

Fijian Minister of Health Ratu Atonio Lalabalavu announced a 90-day plan to respond to the surge in infections, focusing on procuring more drugs and strengthening prevention efforts, including increasing testing. "We have a lot of work to do, a lot to improve, and this is part of the 90-day plan," Dr. Lalabalavu said. Although information about HIV is becoming more common in Fiji, experts say that the Ministry of Health is struggling to catch up.

Renata Ram, UNAIDS Country Director for the Pacific region, said that Fiji's response to HIV is "at least 15 years behind." She said that Fiji lacks preventive drugs such as PrEP and has limited HIV testing. She believes that testing should be provided in any medical service facility. "Unfortunately, this is not the case. Moreover, given the restrictions we face in Fiji, we cannot even start treatment on the same day," Ms. Ram said.

Health experts warn that many cases remain undetected, and Dr. Vakamocea said that this has led to a large amount of avoidable HIV transmission, especially between mothers and newborns. He said that nearly 20 newborns were diagnosed with HIV last year. "This means your system has failed, it has collapsed," Dr. Vakamocea said. Many people who are tested leave false contact information, and if their HIV test results are positive, the health authorities cannot track or manage them.

Dr. Lalabalavu said that one of the reasons is that people believe that the virus is incurable. "We still equate HIV with some kind of death sentence, but HIV is treatable," he said, "We have treatments, and they are free."

But Dr. Vakamocea said that the Fijian Ministry of Health still has much to improve in responding to the epidemic, including launching testing and treatment kits and going deep into the community to find where cases are occurring. "This has never really been incorporated into the Ministry of Health's HIV strategy, which is why we are struggling and where we are today," he said. Fiji has not adopted measures used overseas to control the spread of HIV, such as needle exchange programs, and providing clean needles and syringes to high-risk groups. "This can reduce HIV. These risk mitigation strategies are important," Dr. Vakamocea said.

Mark Lall's partner has been supportive of him in controlling his condition and seeking help. But other people close to him have reacted differently to his diagnosis. When he told his parents that he had HIV, his mother cried. When he went public with his HIV status in January, his father cut off contact with him. "My father comes from a very strict Indian family. I think he was embarrassed when this appeared in the newspaper," Mr. Lall said. His father called him and said that he "should no longer contact the family."

Mr. Lall—who did not contract HIV through drug use—later reconciled with his mother and still hopes to repair his relationship with his father. For him, going public with his diagnosis is part of helping Fiji address the HIV epidemic by raising awareness. Mr. Lall said that there is a taboo that prevents people from talking about sexual health, which creates a barrier to HIV prevention. "People are having sex... but no one is really talking about it," he said.

In Fiji, the strong stigma surrounding sex and HIV makes the recent condom rally in Suva even more remarkable. This is a step towards discussing HIV and sexual health more openly. But experts say that unless the drug crisis is addressed, cases are likely to continue to rise, along with warnings to other countries in the Pacific region. Despite the challenges, Fiji's health system is one of the best in the region. Experts warn that other Pacific countries may be experiencing a surge in HIV that has not yet been detected.

Dr. Vakamocea said that these countries need to wake up, or they will see the impact of HIV and AIDS on public health, "They simply don't know how to deal with it." "Our Pacific Island neighbors definitely need to learn from our experience and start building these systems, or they will be shocked," he said.