South Pacific: HIV Outbreak in Fiji
NEMES LASZLO/SCIENCE PHOTO LIBRARY
The UNAIDS Asia Pacific Regional Director has raised concerns about a sharp increase in HIV infections across Fiji, warning that this trend could put the entire Pacific region at risk. The scale of the outbreak remains underreported, with current estimates suggesting 1,093 cases from January to September 2024, and was recently declared an outbreak by the Health minister. Upon further investigation, the health ministry discovered 223 of the estimated 1093 confirmed cases were linked to the injecting of drugs such as Methamphetamines. Additionally, 202 cases were related to sexual transmission. Although these numbers are relatively low, it is important to note that the population of Fiji is under 1 million. Senior Government officials announced a 90-day effort to fast-track and contain the outbreak: the challenge for the Fijian Government is to break the social stigma around HIV among local communities. Conversations must be had on whether the crisis is a health issue or a transnational crime issue related to the uptake of Methamphetamine by the local population.
The wider concerns of the HIV outbreak are that it is likely to put pressure on the fragile Fijian healthcare system, impact the tourism sector and potentially spread to other Pacific Island Countries creating a regional health security crisis.
Causes of the Crisis
Based on the data of the confirmed cases, 20.4% were linked to the exchange of needles used for Methamphetamine usage. Fijian Prime Minister Sitiveni Rabuka has viewed the outbreak as a criminal issue related to Fiji being a regional corridor for the trafficking of the class A drug from Southeast Asia to markets in Australia and New Zealand.
Local nurse Vilisi Uluinaceva has seen first-hand the impact of methamphetamine usage being tied to the increased transmission of HIV. Miss Uluinaceva framed Fiji as “a hub now for drug trafficking, most of the cases we saw, it's not transmitting through sexual partners, it's through the use of needles and syringes, sharing of the needles”. Tragically, there has been an increase in young people, including children as young as 10, being diagnosed with HIV due to the use of injectable drugs.
Home Affairs Minister, Pio Tikoduadua, has also framed the HIV crisis as a drug issue, arguing "It's affecting our children, our youth, in a big way. We fear for their future”.
#LOCALNEWS | Children below 10 years of age are grappling with the consequences of drug use and HIV.
— The Fiji Times (@fijitimes) August 14, 2024
#TimesNews #FijiNews https://t.co/97xnHA8Euy
Dangerous behaviour and practices include ‘Bluetoothing’ in which a person injects themselves with Methamphetamine, and the partners share blood to get high. This practice has resulted in significant chances of HIV infection, particularly among young people.
In contrast, the perspective among local communities is that the erosion of traditional family values has led to a crisis of identity. In combination, with economic struggles including 4.2% unemployment and rising homelessness in combination with poverty and limited access to affordable housing. As such, a national crisis has unfolded requiring a whole-of-nation approach to dealing with not only the HIV outbreak but the underlying issues of identity and economic stagnation that have led to the increased usage of methamphetamine.
A Spiralling Issue with Local and Regional Implications
At the local level, the stigma around HIV has led to many Fijians refusing to get tested or seeking treatment. Unknowingly, the disease is spreading through sexual intercourse and the use of ‘Bluetoothing’ by younger people. The decision by the Health Minister to declare the HIV outbreak as a crisis challenges the image of Fiji as a “safe and fun” destination for tourists both regionally and internationally.
In individual households, the impact of HIV with family members seeking treatment or dying from the disease will place pressure on household finances. When economic conditions are already dire following the slow rebound of the tourism sector after the COVID-19 pandemic, high unemployment and homelessness are on the rise.
The regional significance of Fiji to the entirety of Oceania as a tourist hotspot and hub for education and commerce cannot be understated. President of the Fijian Medical Association, Dr Alipate Vakamoce has been calling for a greater Government response and a declaration on the issue of rising HIV cases since the spike began in January 2024. Moreover, labor mobility schemes such as PALM have the implications of greater outward migration to Australia and New Zealand. A regional outbreak of HIV would be detrimental to the entire region, requiring an international response to bolster health systems on smaller island states
At the local level, the stigma around HIV has led to many Fijians refusing to get tested or seeking treatment. Unknowingly, the disease is spreading through sexual intercourse and the use of ‘Bluetoothing’ by younger people. The decision by the Health Minister to declare the HIV outbreak as a crisis challenges the image of Fiji as a “safe and fun” destination for tourists both regionally and internationally.
In individual households, the impact of HIV with family members seeking treatment or dying from the disease will place pressure on household finances. When economic conditions are already dire following the slow rebound of the tourism sector after the COVID-19 pandemic, high unemployment and homelessness are on the rise.
The regional significance of Fiji to the entirety of Oceania as a tourist hotspot and hub for education and commerce cannot be understated. President of the Fijian Medical Association, Dr Alipate Vakamoce has been calling for a greater Government response and a declaration on the issue of rising HIV cases since the spike began in January 2024. Moreover, labour mobility schemes such as PALM have the implications of greater outward migration to Australia and New Zealand. A regional outbreak of HIV would be detrimental to the entire region, requiring an international response to bolster health systems on smaller island states.
What is being done?
Health Minister Hon. Atonio Lalabalavu announced the HIV Outbreak Response Plan with a fast-tracked 90-day effort targeting highly vulnerable communities. Furthermore, the severity of higher infection rates has shifted the attitude of the Fijian Government, saying, “This is not only a health issue but can potentially become an economic and developmental issue if we don’t act now.” The current status of containing the outbreak of HIV would require a whole-of-nation approach. Mr Lalabalavu declared “Communities, civil society, faith-based organisations, private sector partners, and international allies must join us in raising awareness, reducing stigma, and ensuring everyone affected by HIV receives the care and support they need.”
The long-term strategy is to incorporate the UN AIDS framework of 95-95-95. The targets of 95% testing, 95% treatment and 95% viral suppression are ambitious and were adopted by UN member states in 2021. To achieve such targets, the Fijian government would need to address poor sex education, the stigma associated with HIV that has led to low testing and increased access to antiviral treatments.
Advocate and survivor of HIV Jokapeci Tuberi Cati is seeking to break the stigma and change perceptions around HIV by raising awareness across Fiji. Ms Tuberi Cati contracted HIV during her first marriage, and her husband later died in 2003 following complications and lack of treatment for the disease on the island. Her approach to raising awareness and declaring action on incorporating the 95-95-95 framework is through ‘talanoa’. A term that refers to open dialogues, sharing knowledge and creating a support network of HIV survivors.
The success in dealing with the HIV outbreak requires regional cooperation to bolster health facilities and treatments of the disease. Prime Minister Rabuka has viewed the issue through the lens of a crime issue through drug trafficking, as well as acknowledging the severity of an unchecked outbreak across the region. Local initiatives to increase funding and awareness campaigns of the disease through education around safe sex and to break the social stigma of HIV survivors by incorporating the stories of survivors such as Jokapeci Tuberi Cati and her advocacy for talanoa. Yet, the wider concerns by locals of a loss of identity and the breakdown of the traditional family structure are needed to incorporate a whole-of-nation approach to tackling the country's challenges.
