Fiji faces record rise in HIV cases driven by bluetoothing, chemsex and needle sharing

At ten years old, he is the youngest person with HIV that survivor advocate Sesenieli Naitala has met. When she founded Fiji's Survivor Advocacy Network in 2013, he was yet to be born. Today, he represents one of nearly 5,900 people living with HIV in Fiji.

Over the past five years, Fiji's HIV cases have skyrocketed elevenfold, from under 500 in 2014 to around 5,900 in 2024. That same year, 1,583 new infections were recorded—a thirteenfold jump on the five-year average—and 41 children aged 15 or younger tested positive, up from 11 in 2023.

Such figures prompted Health Minister to declare an outbreak in January. Assistant Health Minister Penioni Ravunawa warned that new cases could exceed 3,000 by the end of 2025. “This is a national crisis,” he said. “And it is not slowing down.”

The rise of bluetoothing and needle sharing

Underlying Fiji's HIV surge is a sharp increase in drug use, unsafe sexual practices and communal injection methods. Known locally as "bluetoothing" or "hotspotting", the practice involves one person drawing blood after injecting drugs, then passing that same blood to another user.

Kalesi Volatabu, executive director of Drug Free Fiji, encountered bluetoothing on her outreach walks. “I saw the needle with blood right in front of me,” she recalls. “This young woman had already injected, then others were lining up to use the same blood.”

Economic strains and limited access to clean syringes—pharmacies often demand prescriptions, and needle-exchange programmes remain scarce—have driven users to share equipment. The Ministry of Health identified bluetoothing and chemsex, particularly intravenous methamphetamine use during sexual activity, as key drivers of the outbreak. In the first nine months of 2024, 20% of new HIV cases were linked to injection drug use.

Youth and crystal meth

Fiji has emerged as a Pacific trafficking hub for crystal meth, due to its location between major producers in East Asia and the Americas and lucrative markets in Australia and New Zealand. Over the past 15 years, meth has flooded local communities, with users getting younger by the year.

Injectable drug use now accounts for 48% of known HIV transmissions in Fiji, with sexual transmission at 47% and mother-to-child transmission causing most pediatric cases. Experts point to a lack of public education as a root cause of the epidemic.

Challenges ahead

José Sousa-Santos, head of the Pacific Regional Security Hub at the University of Canterbury, warns of a “perfect storm.” Fiji's health system faces staffing shortages, equipment gaps and slow data collection, undermining its capacity to screen, diagnose and treat patients.

Despite efforts to strengthen surveillance, many cases remain undetected, and infections that have already occurred may not be confirmed for years. “What we're seeing now is just the beginning of an avalanche,” Sousa-Santos says. “We cannot stop infections that have already happened.”

Fiji's HIV epidemic is escalating rapidly due to unsafe drug and sexual practices among young people, straining an under-resourced health system.

This topic was reported by BBC.

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