Fiji is facing one of the fastest rising HIV epidemics in the world, with a new pattern of transmission that goes beyond needles to a practice known as bluetoothing—blood sharing during drug use—alongside rising chemsex and widespread meth use. Official figures show a dramatic jump in people living with HIV since 2014 and a spike in new infections in 2024, prompting calls for urgent harm-reduction measures, better testing, and stronger health system capacity. The warning叠 echoes far beyond Fiji’s shores, offering lessons for neighboring countries in the Southeast Asian and Pacific regions, including Thailand.
Background data paint a stark picture. In 2014, Fiji counted fewer than 500 people living with HIV. By 2024 the number had swollen to about 5,900, an elevenfold increase. New infections in 2024 reached 1,583—more than three times Fiji’s usual five-year annual average. Among those newly diagnosed, 41 were aged 15 or younger, underscoring that the crisis touches communities across age groups. Public health authorities declared an HIV outbreak in January, and officials warn that the trajectory could worsen without swift action. The Ministry of Health and Medical Services has signaled that more than 3,000 new HIV cases could be recorded by the end of 2025 if the current patterns persist.
What makes Fiji’s surge particularly alarming is the mechanism of transmission. Bluetoothing—often described in plain terms as “hotspotting”—involves an intravenous drug user injecting into a first person, who then shares blood with others, creating a chain that accelerates the virus’s spread far faster than traditional needle-sharing alone. The practice has emerged as a relatively inexpensive way to get a temporary high, with groups pooling resources to share a single syringe and blood. In Fiji, where access to clean syringes has long been constrained by supply gaps and regulatory hurdles, bluetoothing has become an unwelcome workaround that concentrates risk within tight social networks. Alongside bluetoothing, chemsex—drug use before or during sexual activity, often involving methamphetamine—has intensified the vulnerability of people engaging in sex, further expanding transmission channels.
The role of methamphetamine in Fiji’s HIV story cannot be overlooked. The drug has become more prevalent in local communities, with injection-based use being particularly common in this context. Public health officials report that injectable drug use accounted for a sizable share of known transmissions, alongside sexual transmissions. What binds these elements together is a broader cultural and logistical environment: stigma reduction around HIV has improved testing uptake in some quarters, but stigma remains a barrier for disclosure and treatment in others. Complicating matters are gaps in the health system’s ability to respond quickly—staffing shortages, limited laboratory capacity, stockouts of rapid tests and essential medicines, and uneven distribution channels for prevention tools such as clean syringes and condoms.
Data from the nine months of 2024 illustrate the gravity and scale of the problem. Of the 1,093 new infections identified in that period, about 223 cases—roughly 20%—were linked to intravenous drug use. The proportion of transmissions via injection is a critical marker of how deeply drug use is intertwined with the HIV epidemic in Fiji. The country remains the Pacific region’s epicenter for crystal meth, a factor that magnifies risk through impaired judgment, unsafe sexual practices, and increased sharing of drug-use equipment. In an environment where harm-reduction infrastructure is still developing, such dynamics create a perfect storm for rapid viral spread.
Health authorities acknowledge Bluetoothing as a driver of the surge. The recognition came in August 2024, when officials flagged this practice as a key factor behind rising case counts. The same period highlighted chemsex as another important driver, especially among younger users who mix meth with sexual activity. The Ministry has been trying to bolster surveillance and expand access to preventive and treatment services, but the scale of the epidemic has stretched Fiji’s public health capacity. International partners, including a Global Alert and Response Network, have offered technical support, yet frontline workers warn that current resources are insufficient to reverse the outbreak in the near term. Even as testing becomes more widespread and treatment uptake improves, the true scale of the epidemic may still be larger than official figures suggest due to underreporting and testing gaps, especially in hard-to-reach communities.
The voices of community workers and advocates illuminate the human reality behind the numbers. From Suva’s streets to the country’s clinics, frontline workers describe a shifting landscape of risk. One NGO leader notes the dramatic visibility of bluetoothing as a behavior once whispered in alleyways, now seen in broad daylight in areas of high drug use. “They’re not just sharing needles; they’re sharing blood,” the advocate said, describing a scene that is as alarming as it is now more openly acknowledged. A survivor advocacy group leader adds that more young people are experimenting with drugs, a trend that complicates prevention work given the vulnerability of youth to addiction and unsafe sex. These frontline insights help explain why testing and treatment campaigns are now at the center of Fiji’s public health response.
In public health terms, the Fiji case is a stark reminder that HIV epidemics evolve with drug markets, social networks, and health system capacity. The country’s geography—as a transit hub between major drug manufacturing regions and Pacific markets—has not only shaped the scale of drug trafficking but also the pace at which risky behaviors spread. The epidemic’s trajectory raises questions about the adequacy of harm-reduction policies. Needle and syringe programs, widely recognized elsewhere as a critical preventive tool for people who inject drugs, have faced social, political, and religious sensitivities in Fiji. These factors have created a gap between best-practice public health strategies and what is feasible on the ground, amplifying transmission risks in the short term while long-term strategies are being designed and funded.
From a Thai lens, the Fiji outbreak has clear implications. Thailand has grappled with methamphetamine use and HIV concerns in different settings, and the Fiji experience underscores the importance of rapid, scalable harm-reduction interventions, robust surveillance, and community-led outreach. It also highlights the delicate balance between public health imperatives and social norms that can influence policy choices. For Thai policymakers, the Fiji case reinforces the value of integrating health services with faith-based and community networks—an approach that aligns with Buddhist-influenced values around compassion, nonjudgmental care, and family responsibility. Engaging temple networks, community leaders, and youth organizations could prove essential in expanding testing, reducing stigma, and improving treatment uptake, especially in hard-to-reach urban and peri-urban areas.
Thailand’s health system already prioritizes universal access to HIV testing and antiretroviral therapy, but the Fiji outbreak points to three critical priorities that Thai authorities could learn from: strengthening surveillance to detect shifts in transmission patterns quickly, expanding harm-reduction services to address blood-sharing risks and injection-related infections, and investing in youth-focused prevention programs that address both drug use and safer-sex practices. The Fiji story also indicates a need for regional cooperation in supply-chain management for essential tools such as rapid tests, antiretrovirals, and clean syringes, ensuring that shortages do not undermine life-saving efforts in neighboring countries.
Experts emphasize the importance of not only medical treatment but also social support. For people living with HIV in Fiji, and for their families, community acceptance and access to counseling, mental health services, and peer-led support are essential to maintaining adherence to treatment and staying engaged in care. In Thai contexts, where families often play a central role in healthcare decisions and where community and religious leaders influence behavior, leveraging these networks could accelerate acceptance of testing and treatment while mitigating stigma. The broader regional picture—where HIV, methamphetamine, and unsafe sexual practices intersect—calls for a coordinated strategy that crosses health, social services, law enforcement, and education sectors.
What happens next will determine whether Fiji’s crisis accelerates into a long-term regional challenge or becomes a catalyst for stronger, more preventative health systems. Public health officials warn that this could be the beginning of an avalanche if action remains fragmented or underfunded. For Thailand and other countries in the region, that warning carries both caution and opportunity: invest in comprehensive prevention and treatment programs now, align with international best practices on harm reduction, and integrate public health messaging with trusted community and religious networks to reach youth and marginalized groups before new infections mount.
In practical terms, the Fiji experience suggests several actionable steps that Thai health authorities and communities might consider. First, strengthen surveillance with real-time data integration across laboratories, clinics, and community testing sites to identify clusters quickly and deploy targeted interventions. Second, scale up harm-reduction services, including access to clean injecting equipment and condoms, as well as confidential, stigma-free testing and treatment pathways for people who use drugs. Third, expand youth-focused education that combines information about drug risks with resources for safe sex and HIV prevention, using culturally resonant messages that respect family values and religious norms. Fourth, ensure steady supply chains for medications, testing kits, and prevention tools so stockouts do not derail the treatment cascade. Fifth, foster cross-border collaboration to share best practices, coordinate law enforcement with health protection, and monitor trafficking routes that feed drug markets across the region. Finally, invest in community-led outreach that aligns with local cultural norms, leveraging the influence of families, temples, and community groups to build trust and improve health outcomes.
Ultimately, Fiji’s HIV surge is more than a local crisis. It is a global health signal about how rapidly new risk patterns can emerge when drugs, sexual behavior, and health system capacity intersect in vulnerable settings. For Thai readers, it offers a mirror and a map: a mirror to reflect on domestic vulnerabilities and resilience, and a map to guide proactive, compassionate, and evidence-informed responses that protect families, communities, and the next generation from a preventable public health tragedy. The path forward requires steady political will, community engagement, and sustained resources—principles deeply rooted in Thai values of care, respect for authority, and communal responsibility.