Fiji’s HIV crisis is a syringe crisis and the fix is sitting on a pharmacy shelf

Fiji is grappling with a severe HIV epidemic, declared a national outbreak in January 2025, driven not by sexual transmission but by the sharing of contaminated needles. New HIV case notifications surged dramatically, from 131 in 2018 to 1,583 in 2024, with estimates suggesting over 40 percent of infected individuals are unaware of their status. A significant 48 percent of patients starting antiretroviral therapy in 2024 cited injecting drug use as their main infection route.

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Fiji’s HIV epidemic is not primarily sexual; it is a syringe epidemic.

A World Health Organization and UNDP-commissioned report highlights the critical role of injecting practices among drug users in Suva. The study found that every participant interviewed had shared needles or syringes, and many injected crystal methamphetamine, often with used equipment. A dangerous practice called 'koda,' involving drawing blood into a syringe to mix with drugs before reinjection, is also prevalent and facilitates efficient HIV transmission.

The core issue is the widespread lack of sterile equipment. Pharmacies, the most accessible source for syringes, often deny sales without a prescription, despite this practice lacking legal basis. This forces users to share needles, directly fueling the epidemic. Public health experts point to the decades-old, highly effective solution: needle and syringe programs (NSPs). These programs provide free, sterile equipment without requiring prescriptions, registration, or the return of used kits.

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Pharmacies, the only realistic source of sterile equipment, frequently refuse to sell syringes without a prescription.

NSPs have a proven track record of cutting HIV transmission, not increasing drug use, and being cost-effective. Countries like Australia, New Zealand, and Portugal have integrated NSPs into their public health infrastructure, successfully containing or avoiding widespread epidemics. Fiji's current legal framework, including the HIV/AIDS Decree 2011 and national strategies, provides a policy foundation, but the critical missing piece is the implementation of accessible sterile equipment through NSPs to combat the syringe-driven HIV crisis.

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A needle and syringe program (NSP) provides free sterile equipment to people who inject drugs, without prescription, registration or any requirement to return used kit.