The island paradise with the world’s fastest growing HIV epidemic

Ben took his drugs ‘on the rocks’. Instead of diluting the methamphetamine with water, he’d draw blood into a syringe, dissolve the crystals, and inject himself. Sometimes it was his blood, sometimes a friend’s, and the needle was rarely new. That hardly seemed to matter.

It was 2021 and Ben, whose name has been changed, was living on the streets in Suva – Fiji’s faded seaside capital. Then 20, he’d fled his home after his father and five brothers tried to beat away his bisexuality. Crystal meth’s numbing high became an all-consuming escape from the painful memories.

“I just felt like the love I was looking for was in the streets, it was not at home,” Ben, now a tall, measured 24-year-old, told the Telegraph. “I didn’t consider [safety] at all… I just continued taking [meth]. For me, when I took drugs, it transformed my mind – I was in another world altogether.”

But that world of euphoric highs and shared syringes left its mark long after Ben abandoned Suva’s shabby streets.

By late 2023, he had developed a persistent cough, his hair was falling out, and he was losing weight rapidly – dropping from a waist size 42 to just 22. When he was hospitalised with severe pneumonia, doctors diagnosed Ben with late-stage HIV, then transferred him to a ward notorious in Fiji as the place men go to die.

“That’s how ill I was,” he said, sipping Coca-Cola on the seafront earlier this month. “Lying in that bed with no hope, everything seemed lost and fading.”

As recently as 2020, stories like this were relatively rare in Fiji, a former British colony best known as a paradise archipelago with pristine beaches and a vibrant culture. But now, the small Pacific nation has a grim new accolade: it is struggling to stem the world’s fastest growing HIV outbreak.

“This is the ugly side of Fiji,” said Paulo, another of the five people living with HIV who spoke to the Telegraph in Suva – where children as young as 10 have contracted the virus from injecting drugs, as HIV rips through a country caught off guard.

According to data shared by the Ministry of Health, 147 people were newly diagnosed with the disease in 2020. Just four years later, that number had jumped to 1,583 – and in the first six months of 2025 alone, 1,226 cases were reported. Overall, infections have risen by 3,000 per cent since 2010.

While still a relatively small total compared to Fiji’s population – roughly 930,000 people – patchy testing means diagnosed cases are only the tip of the iceberg. And the trajectory of the outbreak looks ominous: the health department estimates that, without urgent interventions, the country could see 25,000 cases a year by 2029.

“I never thought I’d see another epidemic like this in my lifetime,” said Prof Lisa Maher, an epidemiologist at the Kirby Institute in Sydney, who worked on the HIV response in New York in the 1980s and later in southeast Asia, and is now supporting Fiji. “It came out of nowhere, because there was no data and no surveillance in place.”

The escalating crisis is linked to a boom in drugs that threatens to turn the Pacific into a “semi-narco region”, according to Associate Professor Jose Sousa-Santos, director of the Pacific Regional Security Hub at the University of Canterbury in New Zealand.

The region has long been a strategic stop-off point on a ‘drugs superhighway’ from the Americas and southeast Asia to Australia and New Zealand, where high demand and prices equate to lucrative profits. Yet the route’s popularity is increasing, with organised crime in the Pacific “evolving faster than any previous point in history”, according to a report from the United Nations Office on Drugs and Crime (UNODC).

Chinese triads, Mexican cartels and Australian biker gangs are all operating, even collaborating, in a “thriving criminal ecosystem” that exploits the region’s porous coastlines, weak law enforcement and widespread corruption. Yachts, narco-subs and drones have all been used across the network of air and maritime routes.

Alongside Tonga and Papua New Guinea, a key foothold is Fiji – the transport hub is dubbed the ‘gateway to the Pacific’, while four coups since 1987 have eroded democratic institutions and left them open to infiltration.

Recent seizures by the authorities, including 4.8 tonnes of crystal meth and 2.6 tonnes of cocaine, give a sense of the scale of drugs flowing through the archipelago. Police have also confirmed “wash-ups” of drug packages on outer islands – one story circulating suggests unaware locals in one remote village used the “white stuff” as washing powder after it swept ashore.

Yet the nation is no longer simply a stopover point for criminal syndicates: drugs, predominantly methamphetamines, are also spilling into a booming domestic market.

“A transit country doesn’t usually stay as a transit country,” said Megumi Hara, a regional advisor on transnational organised crime at UNODC, based in Suva. “Eventually, it also becomes a destination – and that’s what we’ve seen here.”

The Telegraph witnessed the thriving trade firsthand. As a deep orange sunset spread above Suva on a Sunday evening, two contacts (on the condition we didn’t name them or the places) took us on a “sightseeing tour” of the city’s many drug-dealer hang outs: behind a grey block of social housing, at a nondescript bus stop on a busy road, and a lush green village just outside town.

“This is one of the drug red zones in Fiji,” said one of our well-connected escorts, as the car spluttered up a steep hillside in the village, past a group of boys lurking under a palm tree. “Even the police are scared to come here… they can’t do anything because the drug lord is the landowner. His children, his brother, his brother’s son – they’re all selling drugs.”

When we paused outside a modest wooden house, a gaunt man in a hoodie immediately sauntered up to the car window – in one hand was a red burner phone, in the other six small sachets of crystal meth. The 28-year-old wasn’t there to talk – he scuttled away as soon as another car pulled up, hoping the driver of the white Toyota might make a better customer.

The sheer volume now circulating on the archipelago is unprecedented. Although surveillance data on use remains limited, the number of cases involving meth reported by the Fiji Police Force jumped 36-fold between 2015 and 2024 – from just 10 arrests to 366.

“Fiji went from having a small number of users, to now having a runaway problem with methamphetamines,” said Prof Sousa-Santos, adding that the market was a deliberate construction.

When organised crime first operated in the Pacific, they developed a network of facilitators – usually people from commercial elites, or with links to law enforcement and government. These connections run deep – between January 2023 and October 2025, the Ministry of Policing said 27 police officers were charged with drug-related offences.

For a fee, corrupt facilitators would ensure the smooth passage of drug shipments through the country. But, as the quantity of drugs grew, criminal syndicates offered to pay in product instead of cash.

From there, local gangs emerged and became increasingly professionalised – by 2018 and 2019, the “white stuff” was not only on the streets, but was starting to be sold on university campuses as “study aids”, and to elites as a sex drug. This trade only accelerated when the pandemic disrupted supply routes into and out of the country.

“If you get paid in the drugs, you have the opportunity to triple or quadruple your return,” said Prof Sousa-Santos. “But to do that, you need a local market. In Fiji, the first market that was targeted was sex workers. It grew and grew from there.”

Perched on the curbside of a dark road in east Suva as friends and customers come and go, a charismatic “drug lord” explains how this market operates on his turf.

Simon, whose name has been changed due to ongoing criminal cases, mainly sold and smoked marijuana but swapped the “green stuff” for the “white stuff” when meth started to hit the streets. The upbeat, 48-year-old reggae musician said he was dealing to “put food on the table” for his children, and make sure users had access to “high quality stuff”.

Now the market “has exploded”, Simon said, his eyes wide. Although he was vague about where he gets the meth he hawks from, there are two main distribution routes.

The first is to sell the substance to other “small-time pushers” at a wholesale price – $2,500 Fijian (£835) for seven grams. These dealers then split the meth into at least a dozen small sachets, generally containing 0.08g of crystals, which they peddle on the streets for $50 Fijian (£17) – effectively doubling their money.

Simon and his partners also employ people to work on their patch, running two four-hour shifts a night. Pushers are paid $50 per shift, during which they’d generally sell at least 14 bags of crystal meth – in Fiji, the national minimum wage is $5 per hour.

But methamphetamines alone do not trigger an HIV crisis: the virus – which spreads through bodily fluids – has found fertile ground because of the way the drugs are being used. Widespread sharing of blood, needles and syringes has transformed a small, background epidemic spreading via unprotected sex into an explosive outbreak.

The shift emerged rapidly. In 2021, the country’s two main sexual health hubs in Suva and Lautoka did not report a single HIV case transmitted through drug use – by 2024, 48 per cent of new HIV infections nationally were among people injecting meth, according to UNAIDS.

“You had a lot of young people, very young people, initiating injecting with no context, no information, no awareness and no access to sterile equipment,” said the Kirby Institute’s Prof Maher, who led a Rapid Assessment on injecting drug use and HIV in Suva, commissioned by the UN and published last year. “A bin fire has become a bushfire.”

While sleeping rough on the seafront in 2021 and again in 2023, Ben engaged in many of the risky drug practices that fueled this “bushfire” – sometimes motivated by intrigue, sometimes culture, and sometimes necessity.

One trend at the time was “bluetoothing”, he said, where friends pooled money to buy a single bag of meth, before one person injected the drug. Once they were high, another person drew blood from the initial user and injected themselves, chasing a secondary rush from the traces of meth in the bloodstream. But while a cost-saving (and headline grabbing) concept, bluetoothing is now uncommon as users found it rarely worked.

Instead, some people have reported using blood, rather than water, as the solvent to dissolve methamphetamine. This involves inserting the needle into a vein and repeatedly “flushing” the plunger back and forth to draw enough blood into the syringe to dilute the crystals, before injecting the entire mixture.

“It gives a stronger high… it gives us a lot of energy,” said Ben, explaining the appeal. He still called this practice “bluetoothing”, but most drug users who spoke to the Telegraph and the Rapid Assessment team referred to the approach as “on the rocks”, “dry” or “koda” – a Fijian word which translates to “raw”, and a nod to a traditional raw fish dish called kokoda.

The rampant HIV transmission has also been driven by sharing of mixing paraphernalia – for instance, using the same bottle caps or mugs to dissolve the meth in water – as well as needles and syringes. In that instance, scarcity has partly been caused by a police crackdown based on a misinterpretation of the law.

“The police started coming down hard on pharmacies for selling needles and syringes to anyone wanting one,” said Renata Ram, the Pacific HIV adviser at UNAIDS in Fiji. “That’s when [the HIV] caseload started increasing as well, in late 2021 and 2022.

“If you really want a hit, you’ll find a way to get it – sharing needles was people’s only option,” she said, adding that selling sterile equipment was never actually illegal. “We’ve heard people saying they would share needles about 15 times, or use the same one 15 times.”

She added that stigma is high but knowledge around HIV is low, with a “whole generation” unaware of transmission risks. Some do not know that treatment exists, so see no reason to test, others diagnosed shun antiretrovirals in favour of traditional Fijian medicines or prayer.

Meri – who, like Ben, asked for her name to be changed because of pervasive stigma in the conservative country – has seen the human cost of the syringe shortage more clearly than most. Within four months last year, she buried three of her closest friends; they were only 33, 42 and 44.

The group started buying methamphetamines just after the pandemic, when they were living on the streets in Lautoka – a city some 120 miles from the capital, on the western side of Fiji’s largest island.

Meri had long been a marijuana smoker, but had never tried the “white stuff” before. Soon the 55-year-old was hooked – she loved “the brightness” and besides, staying awake was useful for long shifts selling cigarettes (some nickname the meth here “mileage”, as it keeps you up for days). But the friends were rarely able to buy sterile equipment – while drugs were everywhere, clean needles and syringes were a luxury.

“They were hard to find, so nearly every time we just shared,” said Meri, sitting cross-legged on a woven mat in a small courtyard at the Survival Advocacy Network (SAN) in Suva. “We washed them, but sharing was kind of [a] necessity.”

Sesenieli Naitala, the founder of SAN, said sharing is also common as it’s hardwired into Fijian life through the custom of “kerekere”, which obliges people to share resources with close friends and relatives. People frequently pass a single cigarette or marijuana joint around a group, while kava – a traditional psychoactive drink – is shared in a single cup.

But in February 2024, Meri tested positive for HIV. She was scared and blamed herself, although she didn’t want to show it – Meri, who wears a cap over her bleach blond pixie cut, attempts an air of nonchalance. She immediately phoned her friends, who still lived on the streets – none of them had considered the risk of blood-borne infections until then.

By the time they were tested, the virus had progressed to Aids. They received treatment, but didn’t stop taking drugs or drinking alcohol and gradually their immune systems faltered. Meri said a final goodbye to two of them in July, and one in October.

“[When I buried them] I was thinking about myself, that I had to change and just leave it behind for good. Because I know if I [keep using] too… it’ll be the same as what my friends went through,” she said softly. “It’s a hard thing to stop [taking meth]… but I had to think of my life.”

It is now more than a year since the Ministry of Health declared a national HIV outbreak and set up a dedicated taskforce to respond, putting Dr Jason Mitchell, a Fijian doctor who’s worked on HIV across southeast Asia and the Pacific, at the helm.

“The way I describe what’s happened here in Fiji is that the epidemic changed, but programming in response to the epidemic did not,” he said. “So our responsibility here in this unit… is to set up an appropriate response for the new epidemic we’re facing.”

The government unlocked $10 million Fijian (£3m) to do so – up from a budget of $200,000 a year – while international support has ramped up, including £1.7m from New Zealand and £2.6m from Australia, who have also invested £25m in a broader Pacific-wide programme. These countries are also supporting law enforcement operations to counter the flow of drugs into Fiji.

But with key elements of the health response beset by delays, critics say the glacial pace is only giving the virus more time to spread, amplifying the “tsunami of infections” they fear is on the horizon. There are also concerns that punitive attitudes and moral framing of drug use is a continued barrier.

There is still no needle and syringe exchange programme, no pre-exposure prophylaxis (PrEP) available, and no rehab centre. There are also major gaps in testing and treatment. UNAIDS estimates that just 36 per cent of people living with HIV in Fiji were aware of their status in 2024, and only 24 per cent were taking antiretrovirals (there have also been sporadic stockouts of the treatment).

Meanwhile the virus is seeping into new groups: in the first half of 2025, 33 babies were born with HIV, signalling broader weaknesses in the health system.

Dr Mitchell conceded that progress has been slower than hoped, and is clearly frustrated by elements of government bureaucracy.

“The outbreak is so large now that it has the potential to impact the country as a whole, the economy and all of the industries that we rely on – such as tourism, which [is where] 40 per cent of our GDP comes from,” the 47-year-old said animatedly, warning there are also signs HIV is starting to spread to other Pacific island nations.

“So it is an emergency. The most frustrating thing is [that] during Covid… things just happened overnight, approvals just happened, finances just flowed, all of that was fast tracked. That has not happened for the HIV response… Why? It’s a question I can’t actually answer.”

But despite red tape, Dr Mitchell stressed there has been major progress behind the scenes to re-build the capacity, expertise and systems needed to respond (while Fiji once had a robust programme to keep HIV at bay, it was gradually sidelined as cases remained low, new health threats emerged and donor funding for HIV was diverted elsewhere).

He is also optimistic that the much needed needle and syringe programme will launch in the second quarter of the year, once the supplies arrive in March, and hopes PrEP will become available for high risk groups within six months.

In the meantime, 11 new HIV care teams have been established at hospitals across the country, free condom pick-up points have been rolled out, and peer-to-peer education programmes are targeting those most at-risk – including the Angels Collective, a group of drug users who are hitting the streets to teach others about safe injecting practices and HIV.

For Dr Kesaia Tuidraki, director of Medical Services Pacific, some of the most important programmes are those taking services directly to communities at risk – whether that’s in the Suva’s suburbs or a remote island three days away by boat, where cases are also emerging.

“If you want to reach people you have to go to where they are, because accessibility has always been an issue,” she said, in an office overlooking the capital’s busy port at the NGO’s modest hillside clinic. “Economical issues, unemployment, challenging backgrounds, geographic isolation, stigma – all these things are stopping people from coming forward.

“This means we’re only seeing the tip of the iceberg, there are a lot more [cases] going unnoticed,” she said, adding that many people only test positive once their infection has deteriorated into Aids. According to government data, more than half of the people who died of HIV-related causes in 2024 found out their status the same year.

And so, as evening rush hour traffic eased, a bus kitted out as a mobile clinic set off to a housing project in the densely populated Suva-Nausori corridor. This is the Moonlight programme, which is trying to stem the glaring testing gap that’s hindering the response.

Within half an hour of arriving, a long queue has formed and HIV, hepatitis and syphilis screening gets underway. Outside the bus, health care workers under a bright hanging torch ask preliminary questions, then prick people’s index fingers and transfer the blood to a rapid test. Some 15 minutes later, results are delivered in private inside the compact mobile clinic.

“Well, we caught some tigers,” Vilisi Uluinaceva, the nurse practitioner, said at the end of a long night. Two of 50 tests came back positive – samples will now be sent to the hospital lab for confirmation, and the patients referred to the main clinic for treatment.

That number is lower than previous screenings – at one, mainly among sex workers, 19 of 25 tests came back positive. But the team is pleased so many young people turned up, as cases in this group are surging: in the first half of 2025 alone, 174 children and teenagers aged between five and 19 were diagnosed nationally. Mrs Uluinaceva has treated patients as young as 13.

“We just have to create more awareness on this issue, because if all these children are going to have HIV, there’ll be no future for Fiji,” she said, holding back tears. “Of course I worry and sometimes I’m really emotional – we just don’t know what the future holds.”

But for Ben, the future finally feels exciting again – he’s found a job and a flat share, and is considering re-enrolling at university. It’s a far cry from the weeks after his diagnosis, when the loneliness felt crushing and thoughts of suicide dominated his mind.

“I have come to understand that HIV is just a sickness like any other,” he said, adding that he has been taking antiretroviral treatment for more than 18 months. “We can all be diagnosed with different illnesses, but what matters is how we accept our condition and maintain a positive mindset.”

Walking through the shallow waters less than two miles from the seawall where he used to sleep rough, Ben also shared uplifting news: last week he found out that, for the first time, his HIV viral load is so low it’s undetectable, thanks to the antiretrovirals. It doesn’t mean the virus has gone, but it means Ben’s condition is stable and he can no longer pass HIV onto someone else.

“Here I am today, just living my life like any other normal person,” he said, beaming.

[Source: Daily Telegraph]