THIS week Fiji declared a HIV national emergency as the country continues to be ravaged by the significant rise in infections and growing concern over transmission within the wider population.
The scale of the crisis is reflected in the sharp increase in new diagnoses in 2025, when Fiji recorded 2,016 new HIV cases, 16 times the number recorded in 2019.
Now the latest statistics reveal an estimated one in every 60 adults now living with HIV, compared with one in 167 five years earlier.
The impact is also being felt sharply among mothers and newborns where an estimated two in every 100 pregnant women are living with HIV, while 59 babies were born with HIV in 2025, 18 of whom died before reaching their first birthday.
The figures have prompted Government to strengthen its response, with a whole-of-government approach aimed at expanding prevention, testing and treatment and reducing the stigma surrounding the virus.
A response that goes beyond health
For Associate Professor Akisi Ravono of the School of Nursing at the University of Fiji, the declaration underlines the urgency of a response that must involve more than the health sector.
“The HIV pandemic in Fiji and the recent announcement by the Minister for Health and Medical Services signify the urgency in the much needed response to the issue,” she said.
“It calls for a collective action by the vanua, Ministry of Health, NGOs and other government ministries and agencies to very quickly put together strategies to assist in curbing the spread of HIV.”
Ravono believes nurses too should be central to that effort. Nurses are the largest category of health professionals in Fiji, she said, and should play leading roles in engaging communities.
“Nurse-led teams must be mobilised now to communities to start educational sessions and demonstrate prevention strategies,” she said.
She also called for test kits to be made available and for a 24-hour helpline for people living with HIV and those who have tested positive.
From concentrated risk to wider transmission
The need for community engagement is also being highlighted by other public health specialists in the region as the epidemic changes.
Dr Jalal Mohammed, Senior Lecturer at the Faculty of Health at the University of Canterbury and Adjunct Professor at the University of Fiji, described Fiji as facing a “once-in-a-generation health crisis”, where HIV diagnoses had risen roughly 3,000 per cent since 2010 and 1,400 per cent since 2022.
While overall prevalence is around one per cent, Dr Mohammed said it is 1.6 per cent among people aged 15 to 49. Accounting for undiagnosed cases, he said, the figure could increase by a further 45 per cent.
According to Dr Mohammed, the epidemic is now moving into what is known as a generalised epidemic phase.
“This means that it is moving from its concentrated risk group, which in Fiji’s case is intravenous drug users, to the generalised population,” he said.
He pointed to increased rates of sexual transmission and mother-to-child transmission as growing concerns.
Mothers and babies among those affected
The impact on children is particularly stark. Fiji’s Ministry of Health has reported that one child is born every week with the virus, while one child dies every month from it.
Dr Mohammed said the scale of the problem means Fiji needs a coordinated national response, backed by the infrastructure and resources required to put that response into practice. Emergency declaration raises expectations
Fiji’s Cabinet has formally declared the outbreak a national emergency under Section 69 of the Public Health Act 1935, a provision last used during the COVID-19 pandemic.
The declaration, he said, recognises the gravity of the situation and the alarming rates of infection and spread. Alongside the HIV/AIDS Act 2011, it strengthens the basis for a whole-of-government and whole-of-society response. A five-minister Cabinet Subcommittee has also been established to remove barriers to rapid action.
But the response cannot rest with Government alone.
“Whole-of-society action calls for coordination and action among the government, faith-based organisations, communities, and the people,” Dr Mohammed said.
He said the declaration provides the impetus for a scaled-up national response, but lessons from countries that have experienced HIV outbreaks of a similar magnitude show that coordination and infrastructure are essential.
“Lessons from countries that have experienced HIV outbreaks of this magnitude, such as Papua New Guinea, reveal that without a nationally coordinated response and infrastructure, it will be challenging to control and reduce the spread of infection and scale up interventions,” he said.
“This is a welcome step, but it requires the resources to support the national strategy, mechanisms, and infrastructure that will allow Fiji to reduce infection rates.”
Breaking down stigma and barriers to testing
For Dr Radilaite Cammock, Associate Professor of Public Health and Deputy Associate Dean – Pacific Advancement at Auckland University of Technology, the reported prevalence of HIV in Fiji shows why the response must reach every part of society.
“I think the escalation is absolutely warranted given the announcement that 1 in 60 Fijians are living with HIV,” she said.
“This is staggering and tells us that the disease is permeating every part of society, not just certain groups in the population.”
Dr Cammock said that means all Fijians have a part to play in addressing the issue.
The response also needs to look beyond medical treatment and consider the social and cultural factors that influence prevention and testing.
She said critical communication and health promotion strategies were needed to address people’s views about getting tested, including concerns about what a positive result might mean.
That includes ensuring people understand that HIV can be managed and treated, while making testing accessible and confidential. Government has said HIV testing remains voluntary and confidential. A person’s HIV status is protected by law and discrimination against people living with HIV is unlawful.
Expanding access to testing and treatment
Expanded testing is already helping health services reach more people and identify cases that may previously have gone undiagnosed. Earlier diagnosis can allow people to access treatment and care sooner.
As part of the national response, Government is expanding free HIV testing, prevention services and treatment. This includes rapid testing, prevention medicine for people at higher risk, harm-reduction measures for people who inject drugs and free treatment for people diagnosed with HIV.
The language of the response matters
But the language used to describe the epidemic matters as well.
Dr Ravono has raised concerns about the use of the term “Red Zones” for areas identified by the Ministry of Health as having a high number of cases.
“This labeling must be removed, as they add to the anxiety and fear of the unknown, about HIV and can be a barrier to health seeking behaviors,” she said.
The concern reflects the wider challenge of stigma. Health services need people to come forward for testing and treatment, while communities need accurate information that does not create additional fear around HIV or people living with the virus.
A role for Parliament and other sectors
Dr Cammock also welcomed the proposal to establish a parliamentary standing committee on HIV and related matters.
She said this would signal a commitment to addressing the issue in Parliament while providing an avenue for different sectors to come together, including education and justice.
A regional concern
The implications of Fiji’s HIV situation also extend beyond its borders.
Dr Sharon McLennan, Senior Research Fellow at the School of Health at Victoria University of Wellington, said Fiji’s declaration was a reminder that increased global and regional connectivity can bring significant public health challenges.
She said the Fiji epidemic had the potential to become a significant regional health concern, particularly given the country’s role as a regional transport, education and business hub.
New Zealand is unlikely to experience a similar surge in HIV cases, Dr McLennan said, but Fiji’s situation remains relevant to New Zealand’s public health interests. Health agencies have already responded through clinical alerts, professional education and public health messaging.
New Zealand has also committed financial and technical assistance to support Fiji’s response, while Australia has recently scaled up its support.
For Dr McLennan, the links between Pacific countries make cooperation an important part of the response.
“These actions represent an important start,” she said.
“Continued investment in prevention, testing and treatment services in Fiji, alongside support for Pacific-led prevention, testing and treatment initiatives in New Zealand will be critical to limiting the longer-term impact of the epidemic.”
Turning a declaration into action
In Fiji, the immediate challenge would be turning the emergency declaration into action that people can see and access in their communities.
That means more testing, prevention and treatment, but also better communication, community education and support for people living with HIV. It means involving nurses, health workers, NGOs, Government agencies, faith-based organisations and communities. And it means ensuring that fear and stigma do not become another barrier to people seeking help.
The national emergency declaration has brought the scale of the HIV situation into sharp focus. The next phase will depend on how quickly the systems, services and community response can be strengthened to meet it.
