The health crisis pushed by a drug crisis

Newsroom

07-07-2025

Six months after Fiji declared an HIV outbreak, driven largely by a growing methamphetamine crisis, UNAIDS' Pacific adviser says other countries around the region are at risk of following suit.
'It does worry me. We have all the risk factors in all the countries that could be another possible crisis like what's happening in Fiji,' says Renata Ram, whose work covers 14 Pacific Island countries.
She says testing of HIV around the Pacific Islands is poor, so they don't have a clear picture of the scale of the problem, but several countries including Solomon Islands, Vanuatu and Tonga have reported an increasing number of cases.
Last year, Fiji had 1583 new cases.
'This is the highest total that they've ever seen. It's a 281 percent increase from 2023,' says Ram.
And while free, life-saving treatment is available, barriers including delays in receiving results, a mobile population, spread-out geography and a stigma about the disease all play in to a relatively low uptake of treatment.
Ram has been working for UNAIDS since 2017, and says the landscape has changed in that time.
'The HIV epidemic was largely driven by sexual transmission; however in early 2019 we started hearing sporadic cases of injecting drug use and domestic drug use, due to all this drug trafficking that was happening through Fiji.'
One practice that has received a lot of attention and blame for spreading the virus is called 'bluetoothing', where one person, after getting a hit, withdraws their blood and shares it with other people. It's a high-risk way of 'sharing' a high, which experts say doesn't work.
It comes with a high risk of contracting various blood-borne diseases, including HIV.
But Ram says this has been overblown.
'There's been a lot of sensationalisation aroud bluetoothing, but it's not the main way people who use drugs actually consume their drugs. It's a very small percentage of people who actually do this.
'Sharing needles is the main cause.'
Ram says that, of the data they are able to get, about 48 percent of people in Fiji have contracted HIV through injecting drugs, compared to about 43 percent from sexual transmission. (There were also 32 cases last year of mother-to-child transmission.)
It's clear that behind the HIV crisis is a drug crisis.
And behind the drug crisis is a change in the way that drug trafficking through Fiji works.
On today's episode of The Detail, an expert in transnational crime explains how drug trafficking through Fiji has changed in the past several years to depend more on local syndicates, and the effect this is having on Fiji's drug use and resulting HIV rates.
José Sousa-Santos, lead and convenor of the Pacific Regional Security Hub at the University of Canterbury, says drugs come through the Pacific Islands to New Zealand and Australia, which, despite being small markets, have some of the highest prices, due to tight control of the market.
But when local traffickers are paid in drugs instead of cash, they need a local market to sell to.
'It's not the larger cartels that are looking at getting the local populations addicted, it's the smaller regional syndicates, the national syndicates, which can now really profit from these local markets.
'This creates ' foot soldiers' who help move drugs through.
'It leads us to see the road map toward Fiji in the future – if this is not addressed urgently – becoming a semi narco state … where the syndicates and the cartels have undue and strong influence over the state itself and where the government will struggle to maintain law enforcement,' he says.
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