Why a tropical paradise has the world's fastest growing HIV epidemic
This third factor refers to a group of people pooling money to buy meth, before one person uses a syringe to inject the drug. Once they're high, another person draws their blood and injects themselves, chasing a secondary rush from the traces of meth in their bloodstream.
'We're gathering from patients that this is now common, and this is part of what's fuelling [the outbreak],' said Dr Tuidraki. 'But because of HIV's long incubation, we're only just seeing the rippling effects of Covid disruption now.'
And the ripples are 'startling'. In the MSP clinic in the capital Suva, Dr Tuidraki has seen a steady flow of new HIV patients in the last 18 months – and unlike the past, many are very young. Too often, they seek care only when their condition is severe, and too often they drop off the radar and stop taking antiretroviral drugs.
'Trends have really changed from what we were seeing before,' Dr Tuidraki said. 'Patients are getting sicker more quickly – perhaps because of the mode of the transmission. The viral load is so high when people share drugs and needles.
'We're also seeing a much younger generation – before, most of the cases [were aged] 29 and above. But it's changed to the point that in our 10 to 19 year-olds, that's where we're having a lot of new cases.'
Dr Tuidraki's observations are reflected in UNAIDS data published last month.
Of new cases in 2024, 60 per cent of cases are among young people aged 10 to 29. Some 48 per cent were linked to injecting drug use – narrowly overtaking sexual transmission, the cause of 43 per cent of known infections, as the main source of spread.
Meanwhile UNAIDS estimates that only a third of roughly 6,000 people living with HIV are aware of their status, pointing to widespread undetected transmission. What's more, just 24 per cent of those affected are currently receiving treatment; without the antivirals, they will almost certainly die.
'This shows there's a hell of a lot of work that needs to be done to get on top of the outbreak, and it needs a different response to the past,' Mr Murphy said.
'[The country] never needed a drug-related response before… but if Fiji doesn't challenge community perceptions around drug use and how to respond to injecting drug use, this epidemic is going to blow up even more.'
Shame and stigma
Yet, even before the current wave of cases, stigma and stereotypes complicated both treatment and prevention efforts in the island nation.
'Fiji is a close knit, faith-based society where privacy is difficult and people fear being judged,' said Mark Shaheel Lal, who founded the awareness group Living Positive Fiji after testing positive for HIV.
He's one of a small group of people living with the virus who have been willing to speak openly about their diagnosis and experience.
'It was a huge shock [to test positive]. But I had a few friends who had passed away from Aids, sadly, because they didn't begin treatment because of the stigma and shame and fear of going to the clinics to get the meds.
'So I felt I had a responsibility to actually come out and help other people living with HIV,' Mr Lal said. 'Conversations about same sex relationships, sex work and sexual health in general remains a taboo here – and this silence keeps HIV hidden, and makes prevention and support so much harder. If Fiji wants to reverse the trend, we must break the silence.'
The government has taken some steps to tackle HIV – including designating the situation as a national outbreak in January.
This allowed for the mobilisation of more resources, including $10 million Fijian (£3m) of new funding, the creation of a dedicated HIV unit in the ministry of health, expanded testing and an awareness campaign. Australia and New Zealand have also pledged support.
But experts have called for drug harm reduction policies, including a needle exchange programme, and warned that a public health response to the meth crisis is needed alongside policing.
They say Fiji should also expand sexual education in schools, ensure the wider availability of pre pre-exposure prophylaxis drugs, and introduce a peer counselling programme in clinics, to offer extra support to those who test positive.
'I'm supportive of the ministry [of health], but there's not been enough implementation yet – there's still a lot of talk,' said Dr Tuidraki. 'The outbreak was declared in January, it's now July. At the end of the day we're trying, but we're not moving with the speed the crisis requires.'
She added that better training for health workers must also be prioritised within efforts to curb transmission, as too many have 'judgemental' mindsets and are 'not well informed on preventative measures'.
'This has been feedback from patients as one of the reasons they stop going in for treatment,' said Dr Tuidraki. 'HIV is too often associated with death, with something that's disgusting… I've been surprised that this is even true among healthcare workers.'
Whether or not Fiji successfully tackles these challenges and reigns in HIV will have ramifications not just for the archipelago, but its neighbours across the region.
'Our big concern with Fiji is both the domestic epidemic, but it's also the gateway to the Pacific,' said Mr Murphy. 'Back in 2001, everyone was expecting an explosion in the Pacific because the background STI [sexually transmitted disease] rates were very high.
'It didn't happen then. But now, it's very much a reality looming.'
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Rise in dengue fever outbreaks across the Pacific driven by the climate crisis, experts say
The climate crisis is driving a sharp rise in dengue fever cases across the Pacific islands, experts say, as infections hit their highest level in a decade and several countries declare emergencies. Pacific Island countries and territories have reported 16,502 confirmed cases and 17 deaths since the start of 2025, according to the Pacific Syndromic Surveillance System (PSSS), which collaborates with the World Health Organization (WHO) and other agencies. Infections across the region are at the highest level since 2016, the WHO said. Fiji, Samoa and Tonga are among the worst affected. Dr Paula Vivili, deputy director general of the Pacific Community (SPC), said historically dengue outbreaks were seasonal. 'However, due to climate change, transmission seasons are lengthening, and some areas are experiencing year-round dengue risk,' Vivili said. 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The Cook Islands has conducted island-wide clean-ups, intensified surveillance and targeted spraying. Tonga has worked with the WHO to bolster its outbreak response in its worst-hit islands, while Tuvalu has turned to social media and health campaigns to promote preventive measures. Samoa has held school clean-ups and boosted public health messaging. New Zealand has sent a clinical team and NZ$300,000 ($178,000) worth of medical supplies to Samoa, alongside on-the-ground personnel and ongoing coordination with Samoan health officials. But experts say these measures are being undermined by inadequate surveillance. 'Current disease surveillance systems are rarely sufficient to manage dengue, as evidenced by the continual growth of dengue in the region, and more generally globally,' said Dr Bobby Reiner, disease ecologist at the Institute for Health Metrics and Evaluation at the University of Washington. Mosquito control tools are methods used to reduce the population of Aedes mosquitoes that spread dengue, such as removing breeding sites, applying larvicides or spraying insecticides. They can also include biological controls, personal protection measures and community clean-up campaigns to prevent mosquito bites and transmission. Still, Reiner said many mosquito control tools had never been proven to reduce transmission, with most responses reactive and often 'wastefully chasing the outbreak, applying effort too late'.
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15 hours ago
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Why a tropical paradise has the world's fastest growing HIV epidemic
Experts have since reported children as young as 10 taking meth, while drug-related deaths – both from addiction and suspected gang activities – are rising. Meanwhile, HIV is being widely transmitted through needle sharing, chemsex and 'bluetoothing'. This third factor refers to a group of people pooling money to buy meth, before one person uses a syringe to inject the drug. Once they're high, another person draws their blood and injects themselves, chasing a secondary rush from the traces of meth in their bloodstream. 'We're gathering from patients that this is now common, and this is part of what's fuelling [the outbreak],' said Dr Tuidraki. 'But because of HIV's long incubation, we're only just seeing the rippling effects of Covid disruption now.' And the ripples are 'startling'. In the MSP clinic in the capital Suva, Dr Tuidraki has seen a steady flow of new HIV patients in the last 18 months – and unlike the past, many are very young. Too often, they seek care only when their condition is severe, and too often they drop off the radar and stop taking antiretroviral drugs. 'Trends have really changed from what we were seeing before,' Dr Tuidraki said. 'Patients are getting sicker more quickly – perhaps because of the mode of the transmission. The viral load is so high when people share drugs and needles. 'We're also seeing a much younger generation – before, most of the cases [were aged] 29 and above. But it's changed to the point that in our 10 to 19 year-olds, that's where we're having a lot of new cases.' Dr Tuidraki's observations are reflected in UNAIDS data published last month. Of new cases in 2024, 60 per cent of cases are among young people aged 10 to 29. Some 48 per cent were linked to injecting drug use – narrowly overtaking sexual transmission, the cause of 43 per cent of known infections, as the main source of spread. Meanwhile UNAIDS estimates that only a third of roughly 6,000 people living with HIV are aware of their status, pointing to widespread undetected transmission. What's more, just 24 per cent of those affected are currently receiving treatment; without the antivirals, they will almost certainly die. 'This shows there's a hell of a lot of work that needs to be done to get on top of the outbreak, and it needs a different response to the past,' Mr Murphy said. '[The country] never needed a drug-related response before… but if Fiji doesn't challenge community perceptions around drug use and how to respond to injecting drug use, this epidemic is going to blow up even more.' Shame and stigma Yet, even before the current wave of cases, stigma and stereotypes complicated both treatment and prevention efforts in the island nation. 'Fiji is a close knit, faith-based society where privacy is difficult and people fear being judged,' said Mark Shaheel Lal, who founded the awareness group Living Positive Fiji after testing positive for HIV. He's one of a small group of people living with the virus who have been willing to speak openly about their diagnosis and experience. 'It was a huge shock [to test positive]. But I had a few friends who had passed away from Aids, sadly, because they didn't begin treatment because of the stigma and shame and fear of going to the clinics to get the meds. 'So I felt I had a responsibility to actually come out and help other people living with HIV,' Mr Lal said. 'Conversations about same sex relationships, sex work and sexual health in general remains a taboo here – and this silence keeps HIV hidden, and makes prevention and support so much harder. If Fiji wants to reverse the trend, we must break the silence.' The government has taken some steps to tackle HIV – including designating the situation as a national outbreak in January. This allowed for the mobilisation of more resources, including $10 million Fijian (£3m) of new funding, the creation of a dedicated HIV unit in the ministry of health, expanded testing and an awareness campaign. Australia and New Zealand have also pledged support. But experts have called for drug harm reduction policies, including a needle exchange programme, and warned that a public health response to the meth crisis is needed alongside policing. They say Fiji should also expand sexual education in schools, ensure the wider availability of pre pre-exposure prophylaxis drugs, and introduce a peer counselling programme in clinics, to offer extra support to those who test positive. 'I'm supportive of the ministry [of health], but there's not been enough implementation yet – there's still a lot of talk,' said Dr Tuidraki. 'The outbreak was declared in January, it's now July. At the end of the day we're trying, but we're not moving with the speed the crisis requires.' She added that better training for health workers must also be prioritised within efforts to curb transmission, as too many have 'judgemental' mindsets and are 'not well informed on preventative measures'. 'This has been feedback from patients as one of the reasons they stop going in for treatment,' said Dr Tuidraki. 'HIV is too often associated with death, with something that's disgusting… I've been surprised that this is even true among healthcare workers.' Whether or not Fiji successfully tackles these challenges and reigns in HIV will have ramifications not just for the archipelago, but its neighbours across the region. 'Our big concern with Fiji is both the domestic epidemic, but it's also the gateway to the Pacific,' said Mr Murphy. 'Back in 2001, everyone was expecting an explosion in the Pacific because the background STI [sexually transmitted disease] rates were very high. 'It didn't happen then. But now, it's very much a reality looming.'
The Guardian
a day ago
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Rise in dengue fever outbreaks across the Pacific driven by the climate crisis, experts say
The climate crisis is driving a sharp rise in dengue fever cases across the Pacific islands, experts say, as infections hit their highest level in a decade and several countries declare emergencies. Pacific Island countries and territories have reported 16,502 confirmed cases and 17 deaths since the start of 2025, according to the Pacific Syndromic Surveillance System (PSSS), which collaborates with the World Health Organization (WHO) and other agencies. Infections across the region are at the highest level since 2016, the WHO said. Fiji, Samoa and Tonga are among the worst affected. Dr Paula Vivili, deputy director general of the Pacific Community (SPC) said historically dengue outbreaks were seasonal. 'However, due to climate change, transmission seasons are lengthening, and some areas are experiencing year-round dengue risk,' Vivili said. Dengue fever, a viral illness spread by Aedes mosquitoes, causes high fever, severe headache, joint and muscle pain, rash, and in severe cases, can be fatal. Rising temperatures, rainfall and increased humidity are creating ideal breeding conditions for Aedes mosquitoes, even in areas previously unsuitable for transmission. 'Dengue is one of the first real disease-related phenomena that we can lay at the foot of climate change,' said Dr Joel Kaufman, epidemiologist and director of the Center for Exposures, Diseases, Genomics and Environment at the University of Washington. 'Rainfall raises the waterline over mosquito eggs laid just above the surface, which then hatch – that's part of the natural breeding cycle. Heavy rains can also increase stagnant water sources, creating more opportunities for mosquitoes to breed,' said Kaufman. Kaufman warned these outbreaks point to a wider public health challenge. 'It is in the vanguard of what will certainly be many types of human disease that become more common and more serious as the planet warms.' Since declaring an outbreak in April, Samoa has confirmed six dengue-related deaths, including two siblings, and more than 5,600 cases. This year Fiji has recorded eight deaths and 10,969 cases. Tonga has reported over 800 cases and three deaths, since declaring an outbreak in February. These outbreaks underscore the region's vulnerability to climate-sensitive diseases, which are expected to intensify as global temperatures rise. Pacific Island countries produce just 0.03% of global greenhouse gas emissions, according to the Intergovernmental Panel on Climate Change (IPCC), but face some of the most severe climate-related health threats, including vector-borne diseases. Recent months have brought extreme rainfall to parts of the Pacific including Palau, Papua New Guinea and Solomon Islands, while severe drought has gripped parts of the Marshall Islands, Papua New Guinea, Nauru and Fiji, according to the New Zealand National Institute of Water and Atmospheric Research (NIWA). Forecasts show these contrasts will continue into October. Although higher rainfall has been attributed to ideal conditions for mosquito breeding, Kaufman said that extreme weather events can also increase transmission of mosquito-borne diseases. Seriously dry or very dry conditions were recorded across large parts of the Pacific in the first half of the year, according to NIWA. 'We might have thought the dryness would reduce mosquito-borne infections, but it seems that's not what happens. Instead, there's an acceleration of transmission.' Across the Pacific, national responses have varied. Samoa, Cook Islands and American Samoa have declared emergencies. The Cook Islands has conducted island-wide clean-ups, intensified surveillance and targeted spraying. Tonga has worked with the WHO to bolster its outbreak response in its worst-hit islands, while Tuvalu has turned to social media and health campaigns to promote preventive measures. Samoa has held school clean-ups and boosted public health messaging. New Zealand has sent a clinical team and NZ$300,000 ($178,000) worth of medical supplies to Samoa, alongside on-the-ground personnel and ongoing coordination with Samoan health officials. But experts say these measures are being undermined by inadequate surveillance. 'Current disease surveillance systems are rarely sufficient to manage dengue, as evidenced by the continual growth of dengue in the region, and more generally globally,' said Dr Bobby Reiner, disease ecologist at the Institute for Health Metrics and Evaluation at the University of Washington. Mosquito control tools are methods used to reduce the population of Aedes mosquitoes that spread dengue, such as removing breeding sites, applying larvicides, or spraying insecticides. They can also include biological controls, personal protection measures, and community clean-up campaigns to prevent mosquito bites and transmission. Still, Reiner said many mosquito control tools have never been proven to reduce transmission, with most responses reactive and often 'wastefully chasing the outbreak, applying effort too late'.
