On 1 October, Fiji’s parliament passed an amendment to the HIV/AIDS Act of 2011, allowing its Health Minister to authorise the distribution of sterile injecting equipment. When the law is gazetted, Fiji will become only the second Pacific island nation, after Papua New Guinea, to embrace a formal needle and syringe programme.
The law arrives in the middle of one of the world’s fastest-growing HIV epidemics, driven in large part by injected methamphetamine. Fiji recorded 2,016 new diagnoses in 2025, its highest annual total, and its Health Ministry now estimates that one in 60 adults is living with HIV. The country recorded 117 HIV-related deaths in 2025. Among cases with a known route of transmission, more than 42% were linked to injecting drug use.
The imported needles are currently sitting in a warehouse in Suva, the nation’s capital, waiting for the law to become official and the rollout to begin. Sources close to the programme suggest that some equipment is already being distributed.
Unprecedented outbreak
Fiji’s HIV epidemic has ballooned rapidly in recent years, with numbers increasing roughly twelve-fold since 2010 and four-fold in the last three years alone, according to Eamonn Murphy, director of UNAIDS’ regional support team for Asia Pacific and Eastern Europe and Central Asia. Prior to the outbreak, Murphy said that Fiji had mostly seen a small number of HIV cases, mostly transmitted sexually.
“Something changed, and that was injecting drug use of crystal meth,” according to Murphy.
Fiji has long been a waypoint for drugs moving from South America and Southeast Asia to Australia and New Zealand. Australia has some of the highest drug prices in the world, making it an attractive market for sellers. Ships make their way through the Pacific and stop off on islands along the way, though its illegal cargo isn’t usually distributed along the route. This, however, has recently changed, with Murphy pointing to the Covid-19 pandemic as a likely turning point.
A rapid assessment on the HIV situation in Fiji, led by the Australian Kirby Institute, began in March 2025. It found that every single participant had, at some point, reused a needle after someone else because they couldn’t get sterile ones. The epidemic has shifted from one primarily driven by sex to one driven by drug use, prompting Fiji to enact its pioneering legislation.
Building bridges
Dr Jason Mitchell, Chair of the National HIV Outbreak Cluster Response Taskforce, who is spearheading the country’s response to the epidemic, said that the scarcity of needles was partly a result of law enforcement. Needles had once been easy to buy until the police began clamping down on pharmacies selling them. This encouraged drug-injecting groups to share equipment and thereby pass on infection.
Winning over law enforcement was an early goal for those pushing harm reduction, Mitchell says, a goal which he largely sees as achieved. The turning point was a study tour to Australia that happened this year, where Fijian officers saw police, town councils and health services working together, including at supervised injecting rooms.
“That was a game changer for us,” Mitchell said.
With its new laws, Fiji is now leading the way in the Pacific on how to respond to rising HIV transmission rates. But within Fiji itself, Mitchell credited leadership well beyond the Ministry of Health. Mitchell described a “three-legged stool” of collaborative governance without which the programme could not stand.
In the build-up to the programme, Mitchell briefed the Great Council of Chiefs, Fiji’s traditional leaders, who agreed to be guided by the Ministry. There’s also been cross-party support for the measures, both at high levels of government and in the opposition. The final piece, he said, is faith-based organisations, which have supported the measures.
“Without each leg,” Mitchell said, “the stool would topple over.”
Building peer knowledge
Fiji’s venture into harm reduction hasn’t missed a factor that many researchers point to as a key to success: the inclusion of people from the drug-using communities. Timi Rarama (Team Light) began in October 2025 as a pilot funded by the Australian Government Department of Foreign Affairs and Trade (DFAT). Professor Lisa Maher of the Kirby Institute said it is still “the only dedicated peer education outreach program for people who inject drugs in Fiji”.
Ele Morrison, deputy CEO of AIVL, Australia’s national organisation of people who use drugs, helped train the first cohort of community outreach workers. “We were expecting 10. 15 turned up on the day and we ended up recruiting all of them,” she proudly told TalkingDrugs.
Almost none of those who answered the call had prior knowledge about harm reduction. “People truly did not know that sharing syringes was an HIV risk,” Morrison said, and there was no tradition of outreach to build on. “That basic knowledge just wasn’t there in Fiji.”
After a week of training on HIV, hepatitis C, testing pathways, boundaries and mapping injecting hotspots, they went straight out into their communities. They’ve been doing it ever since, with each one being paid for 12 hours a week.
From the first day, the workers were being asked whether they had syringes, according to Morrison. But the law hadn’t yet changed to explicitly protect those delivering harm reduction, and the outreach workers faced real risk.
“It’s not safe being identified as a drug user in Fiji,” Morrison said. “Our educators are very brave.”
But these people have support that comes right from the top. Mitchell called peer outreach workers “our most important tool”, due to the complexity of reaching communities of people who use drugs.
Fiji – an archipelago of over 100 inhabited islands – has a complicated geography for distribution; mobile, community-embedded workers are vital to the programme’s success, Mitchell said.
Connecting networks
The ambition for this cohort goes far beyond individuals venturing into their communities. Fiji has sex worker and trans networks, but there’s never been one for people who use drugs. The desire is there, Morrison said, and she hopes the current cohort will found an independent organisation of their own, eventually running their own harm reduction services.
Despite protection under the new laws, the outreach workers still face significant challenges. As well as cultural pushback and stigma, trust is a notable sticking point between the workers and the institutions supporting them. One person involved in the peer programme described institutions as having “a real fear about people who use methamphetamine”.
The ideal peer educator for the institutions, they said, would be someone who stopped using drugs long ago. Though some peer educators may not be drug users, their effectiveness in reaching people who are is often dependent on how active they are in their community. This tension can be uncomfortable between the educators and institutions such as the Ministry of Health and the UN, the person said.
Professor Maher’s prescription is explicit: services need “true peers”.
Making progress
Nobody expects a fast turnaround. The programme will begin official rollout once the law is gazetted. Unofficially, the rollout is already happening, sources told TalkingDrugs.
Distributing supplies, though, might be the easy part. “Supplies are cheap, but that’s not necessarily the issue,” Murphy said. The constraint is staff, in a country where skilled health workers are routinely poached for jobs overseas. “The next time you go,” according to Murphy, “you find out they’re working somewhere else.”
Professor Maher was blunt in her assessment: “We know from experience these things have a very long tail and unfortunately this outbreak is going to get worse before it gets better.”
But the act is a signal, not just that Fiji is confronting this crisis head-on, but that other Pacific island nations could do as well. Students from smaller Pacific states often pass through Fiji’s education system, taking lessons learned home with them. Murphy believes Fiji is “setting a model for others” as they face similar emergencies of spiking drug use with no harm reduction in place – emergencies brought on by rapidly shifting drug markets.
Mitchell had a simple offer for other nations facing similar challenges: “Send your people here, learn with us, we’re all in this together.”
His message to his fellow island neighbours is clear: “We could have intervened here five years ago. We didn’t.”
As ever, the best time to intervene would’ve been earlier, and the second-best time is now. Fiji is leading the way, radically changing its approach to try and save lives.
