HIV Never Left — Kerbside Consult 24/2026

A national emergency in the Pacific

On 15 September 2026, Fiji formally declared HIV a national emergency. WHO reported that an estimated 9,100 people were living with HIV in Fiji in 2025 — about twelve times the 2010 number. Only 39% were thought to know their status, and only 22% were accessing antiretroviral treatment.

Fiji recorded 2,016 new diagnoses in 2025, a 27% increase over 2024. Two-thirds of diagnoses were among people aged 20 to 34, according to the Fiji HIV Surveillance Report 2025. These are diagnoses, not necessarily infections acquired in that same year, but their scale and direction are unmistakable.

This is a country of fewer than one million people. UNAIDS estimates put adult prevalence at about 1.6% — close to one adult in 60. The phrase “fastest-growing epidemic in the world” has been used at AIDS 2026; the more cautious conclusion is enough: Fiji is experiencing one of the sharpest recent increases in HIV anywhere.

Effective treatment does not end an epidemic when testing, prevention and trust fail to reach the people who need them.

How a preventable epidemic accelerated

There is no single explanation. The route of transmission was recorded for only 849 of Fiji’s 2,016 diagnoses in 2025. Among those with a known route, 50.6% were attributed to sexual transmission and 42.6% to injecting drug use. Because the route remained unknown in 57.9% of all diagnoses, these proportions should not be generalised to the entire epidemic, according to the national surveillance report.

Methamphetamine injection has created highly connected transmission networks. A WHO rapid assessment interviewed 56 people who inject drugs; every participant reported having reused a needle or syringe after somebody else at some point. This was a small, targeted sample and should not be treated as a national prevalence estimate. It nevertheless documents an urgent absence of safe injecting equipment.

Molecular surveillance presented at AIDS 2026 found large, closely connected clusters involving people who inject drugs, with evidence of both injecting and sexual transmission. The conference abstract (OAC0206LB) concluded that rapid access to sterile needles, syringes and other injecting equipment could have limited transmission.

Some reports have highlighted unusual blood-sharing practices. WHO’s assessment found little evidence that such practices were widespread. The better-supported explanation is less sensational: scarce sterile equipment, criminalisation, stigma, interrupted supplies, delayed testing and inadequate treatment coverage.

The children should have been protected

In its emergency announcement, Fiji’s government reported that 59 babies were born with HIV in 2025 and that 18 died before their first birthday, figures reported by Reuters. The subsequently published surveillance report classified 57 diagnoses as mother-to-child transmission, including 56 children aged 0 to 4. These figures may reflect different definitions, reporting dates or cohorts and should not be treated as directly interchangeable. Either measure describes a serious failure of prevention and care.

AIDS 2026 speakers cited a vertical-transmission figure of 18%. However, the published national surveillance report does not provide the denominator or calculation required to verify that rate, so it should be treated cautiously.

Mother-to-child transmission is not inevitable. HIV testing before or early in pregnancy, prompt antiretroviral treatment, viral-load monitoring, appropriate management during birth, infant prophylaxis and follow-up can reduce transmission dramatically. Thailand was validated in 2016 as the first country in Asia to eliminate mother-to-child transmission of HIV and syphilis as a public-health problem. Malaysia followed in 2018, becoming the first country in WHO’s Western Pacific Region to achieve this milestone. Fiji’s infant cases therefore represent failures of reach and continuity, not an absence of medical knowledge.

Fiji’s infant cases represent failures of reach and continuity, not an absence of medical knowledge.

Treatment changed HIV — but access decides the outcome

There is still no cure for HIV, but modern antiretroviral therapy can suppress the virus, restore immune function and allow people to live long, productive lives. A person who takes treatment and maintains an undetectable viral load does not sexually transmit HIV: Undetectable equals Untransmittable, or U equals U.

That scientific achievement only matters when people are diagnosed, started on treatment and supported to remain on it. Fiji’s estimated cascade — 39% aware of their status and 22% receiving treatment — is far behind the global position. In 2025, WHO estimated that 88% of people living with HIV globally knew their status, 89% of those diagnosed were receiving treatment and 95% of those treated had viral suppression.

Fiji has introduced dolutegravir-based treatment, but clinics have reportedly experienced shortages of test kits and antiretroviral medicines. One case of pretreatment dolutegravir resistance was identified in the AIDS 2026 molecular study. It does not establish a widespread resistance problem, but it reinforces the need for uninterrupted treatment, viral-load testing and resistance surveillance.

U=U is a scientific fact — but it only protects a population once people are diagnosed, treated and supported to stay on treatment.

Prevention is more than a school lecture

Education matters, but information alone cannot compensate for services that are unavailable, unaffordable or frightening to use. Effective prevention has to connect knowledge with practical choices.

Young people need age-appropriate, medically accurate education about HIV, other sexually transmitted infections, condoms, consent, testing and where to obtain confidential help. Messages based only on fear or morality drive risk underground. Education should also explain that HIV can affect anyone, that ordinary social contact does not transmit it, and that a person with sustained viral suppression does not transmit it sexually.

The prevention package is already known: accessible condoms; confidential facility-based, community and self-testing; rapid linkage to treatment; oral or injectable pre-exposure prophylaxis, or PrEP; post-exposure prophylaxis after a significant exposure; sterile injecting equipment and opioid-agonist treatment where appropriate; antenatal testing and treatment; and protection from discrimination.

Needle-and-syringe programmes are a public-health intervention, not an endorsement of drug use. They prevent blood-borne infection, create contact with health services and provide a route into treatment and recovery. Policing that discourages pharmacies from supplying sterile equipment can unintentionally increase the very harm it seeks to control.

A vaccine would help. It does not yet exist

There is currently no licensed vaccine that prevents HIV. Research continues, but HIV’s rapid mutation, genetic diversity and ability to integrate into human cells have made vaccine development exceptionally difficult.

Long-acting prevention should not be confused with vaccination. In 2025, WHO recommended twice-yearly injectable lenacapavir as an additional PrEP option. Long-acting cabotegravir, given every two months, and daily oral PrEP are other effective options. These medicines prevent acquisition while active in the body; they do not train the immune system in the way a vaccine does. Their population benefit will depend on price, supply, testing and equitable access.

Treatment is also becoming more flexible. WHO’s 2026 clinical guidance supports long-acting injectable antiretroviral treatment for selected adults and adolescents who have difficulty adhering to daily tablets. It is an option for particular patients, not a substitute for reliable everyday treatment services.

The regional warning

Fiji’s situation is exceptional in speed, but it is not isolated from the region. The epidemics differ, and direct numerical comparisons can mislead because surveillance systems, denominators and testing intensity vary. The direction of travel nevertheless matters.

HIV care also cannot stop at national borders. Travel, labour migration, education and family ties connect countries across the Pacific and beyond. Regional preparedness should not stigmatise migrants or treat them as the problem. It should protect continuity of confidential testing, PrEP and treatment when people move between health systems.

Country	What the comparison shows
Malaysia	Malaysia reported 3,185 new HIV cases in 2024. The Ministry of Health told Parliament that 90% were among men, three-quarters were among people aged 20 to 39 and 96% were attributed to sexual transmission. These patterns require sustained testing, treatment and prevention. The Ministry now has a national PrEP implementation guideline.
Thailand	Thailand demonstrates what long-term political commitment, universal treatment and community-led services can achieve. By 2022, around 94% of people living with HIV knew their status, 91% of those diagnosed were receiving treatment and 97% of those treated were virally suppressed. Stigma and continuing infections still require attention.
Philippines	WHO and UNAIDS describe the Philippines as having the fastest-growing number of HIV cases in Asia-Pacific. Estimated new cases rose from 4,400 in 2010 to 29,600 in 2024; one-third of diagnoses in early 2025 were among people aged 15 to 24.
Indonesia	Indonesia’s large, geographically dispersed epidemic shows why prevention and treatment must be decentralised and community-led. National totals can conceal major gaps among key populations and between provinces.
Singapore	Singapore reported 151 new diagnoses among citizens and permanent residents in 2024, but 51.7% were diagnosed at a late stage. Lower national numbers do not remove the need for routine testing, PrEP access and stigma-free care.

What Malaysia should take from Fiji

Malaysia is not Fiji, and it should not be described as being on the same trajectory. But waiting for prevalence to rise before strengthening prevention would repeat the central mistake exposed by Fiji.

The priorities are clear, even if implementation is not: make confidential testing normal; diagnose earlier; start treatment promptly; maintain medicine and test-kit supplies; expand PrEP through public, private and community services; teach young people before exposure rather than after diagnosis; preserve harm-reduction services; and measure viral suppression, not merely the number of tablets dispensed.

Healthcare workers also need to make every clinical encounter safer. A sexual history should be taken without judgement. HIV testing should be offered according to risk and clinical indication, including in people with tuberculosis or recurrent sexually transmitted infections and as part of antenatal care. A positive result must lead to treatment and support, not blame.

Fiji did not run out of science. It ran short of reach: too few tests, too little sterile equipment, treatment interruptions and too much stigma.

HIV never left. We should not wait for a national emergency to notice it again.

Sources & further reading

Fiji: emergency declaration and surveillance

Global evidence and WHO guidance

Eliminating mother-to-child transmission

Malaysia: policy and data

Regional comparisons

Published 24/2026 · 23 September 2026 · No corrections to date · Corrections policy