Fiji prepares needle‑syringe programme to curb HIV outbreak among drug users

Fiji’s Minister for Health declared a national HIV outbreak in January 2025 after case notifications rose twelve‑fold from 131 in 2018 to 1,583 in 2024. Modelling suggests around 6,100 people are living with HIV, with more than 40 % unaware of their status. Among patients who started antiretroviral therapy in 2024, 48 % identified injecting drug use as the primary transmission route, making shared syringes the main driver of new infections.

A rapid assessment commissioned by the WHO and UNDP and conducted by the Kirby Institute (published December 2025) found that every interviewee had shared a needle, many practiced “koda” (mixing drug crystals with blood drawn into the syringe), and pharmacies routinely refused to sell syringes without a prescription despite no legal prohibition. The report recommended a needle‑and‑syringe programme (NSP) that provides free sterile equipment without prescription or registration. Fiji’s health ministry confirmed the decision to implement an NSP in December 2025, and the June 2026 budget update said preparations were “nearing completion.”

While the NSP is being readied, continued lack of sterile equipment is leading to rising HIV and hepatitis C infections, infective endocarditis, and deaths among young people arriving in septic shock. Cultural and political opposition from some health officials, police and religious leaders, who view provision of syringes as endorsing drug use, remains a barrier to rapid rollout.