By MONICA KAYOMBO, Rio De Janeiro, Brazil
FIJI is mounting an aggressive response to what health experts now describe as the world’s fastest-growing HIV epidemic, warning that failure to act decisively could reverse decades of progress against HIV in the Pacific while allowing hepatitis C to emerge as another major public health crisis.
The urgency of the situation dominated a journalists’ roundtable held on the sidelines of the 2026 International AIDS Conference in Rio de Janeiro, where global HIV leaders warned that Fiji’s outbreak is no longer solely a national concern but a regional and international public health issue requiring sustained political commitment, stronger prevention programmes and increased financial investment.
Held under the conference theme “Rethink. Rebuild. Rise.”, the discussion brought together scientists, policymakers, civil society leaders and communications experts to examine Fiji’s rapidly evolving epidemic and explore lessons for HIV prevention, harm reduction, health systems strengthening and regional collaboration.
The panel featured Ms Sharon Lewin, Director of the Doherty Institute for Infection and Immunity in Australia, as moderator, alongside Dr Jason Mitchell, Chairman of the Fiji National HIV Outbreak Cluster Response Taskforce; Mr Mark Shaheel Lal, Founder of Living Positive Fiji; Alexis Apostolellis, Chief Executive Officer of ASHM Health Australia; Dash Heath-Paynter, Chief Executive Officer of Health Equity Matters Australia; and Raybert Domingo, Strategic Communications Advisor at Love Yourself Philippines.
The discussions come at a time when the global HIV response faces growing financial uncertainty, with experts at the AIDS 2026 Conference repeatedly warning that reductions in international donor funding threaten to undermine decades of gains in HIV prevention, treatment and care, particularly in low and middle-income countries.
Against that backdrop, Fiji has emerged as one of the countries requiring urgent international attention.
Speaking in an exclusive interview after the roundtable, Dr Mitchell said the country’s epidemic has reached levels never seen before and is now affecting populations previously considered to be at relatively low risk.
“Our prevalence right now in adults aged 15 to 49 years is 1.6 per cent, which is quite significant,” he said.
“That means one in every 60 adults in Fiji has HIV.”
More worrying, he said, is the increasing number of pregnant women testing positive.
“The prevalence in antenatal care is already above two per cent. We now have a large number of pregnant women infected with HIV, and this is another population we urgently need to focus on.”
Dr Mitchell said this trend threatens years of progress in preventing mother-to-child transmission of HIV.
Babies continue to be born with HIV
One of the strongest messages emerging from Fiji’s response is the urgent need to strengthen HIV screening during pregnancy.
Dr Mitchell disclosed that 59 children were diagnosed with HIV last year, translating into approximately one new paediatric HIV infection every week.
“That’s one child diagnosed every week with HIV, and one child dies every month from HIV,” he said.
Unlike previous years, many expectant mothers initially test HIV-negative before becoming infected later in pregnancy.
“What we didn’t have in Fiji before was repeated HIV testing during pregnancy,” he explained.
“Now we want pregnant women to have three HIV tests. The minimum is two, but three is the goal.”
According to Dr Mitchell, repeated testing has become necessary because some women acquire HIV during pregnancy after exposure through partners engaging in high-risk sexual behaviour or because they themselves belong to high-risk groups, including sex workers and people who inject drugs.
“In Fiji now, many women are high-risk populations. We need prevention programmes during pregnancy so women remain HIV-negative, while those who become positive are started on treatment immediately.”
Health experts say early diagnosis combined with effective antiretroviral therapy remains the most effective strategy for preventing babies from acquiring HIV from their mothers.
Young people driving the epidemic
The epidemic is also disproportionately affecting young adults, raising concerns about its long-term social and economic consequences.
Dr Mitchell revealed that the majority of infections are occurring among people aged 20 to 34 years, while infections among adolescents have increased 45-fold.
The rising infections among people in their most productive years threaten not only Fiji’s health system but also the country’s workforce, economic productivity and future development.
The country also recorded 115 HIV-related deaths last year.
“For a small country, 115 deaths from a preventable disease is significant,” Dr Mitchell said.
Treatment alone will not end the outbreak
While access to HIV treatment has expanded, Dr Mitchell acknowledged that poor adherence to medication remains one of the biggest barriers to controlling the epidemic.
“People do not take treatment as prescribed, meaning their viral load remains high.”
Although the exact reasons remain unclear, he believes stigma, discrimination, fear of disclosing HIV status, cultural beliefs and poor health-seeking behaviour are likely contributing factors.
“We actually haven’t done enough research to fully understand why adherence is poor.”
To improve treatment outcomes, Fiji has partnered with Australia’s Burnet Institute to establish peer counselling programmes led by people living with HIV.
The country also plans to strengthen counselling and social work services, although limited financial and human resources continue to constrain implementation.
Hepatitis C emerging as the next crisis
Beyond HIV, Fiji faces another growing health threat linked to injecting drug use.
Dr Mitchell warned that hepatitis C infections are increasing rapidly because of unsafe injecting practices.
“We believe we already have an epidemic of hepatitis C.”
He said expanding HIV services without integrating hepatitis C prevention, testing and treatment could allow another epidemic to take hold.
“We need needle and syringe programmes, stronger peer outreach and hepatitis C testing.”
“If we continue leaving infected people undiagnosed, they will continue infecting others.”
The warning comes as public health experts increasingly advocate integrated approaches that address HIV, viral hepatitis and substance use simultaneously rather than through separate programmes.
Regional implications
Dr Mitchell cautioned that Fiji’s outbreak has implications extending well beyond its borders.
Often described as the gateway to the Pacific, Fiji serves as a major transport hub linking island nations with Australia, New Zealand and Asia.
Thousands of tourists, migrant workers and international students pass through or live in Fiji every year.
“The potential for infections to spread to other countries is very strong,” he warned.
International students are particularly vulnerable because many arrive from countries where injecting drug use is uncommon and prevention services are limited.
“They are exposed to the same risks as our own population, yet we don’t always have adequate support systems for them.”
Experts say strengthening prevention programmes in Fiji would therefore also strengthen health security across the Pacific.
Government commitment and international partnerships
Despite funding challenges, Dr Mitchell praised the Fiji Government for assuming the largest share of financing for the national HIV response.
“The majority of our support comes from the Fiji Government, and I’m very proud of that.”
He also acknowledged the rapid assistance provided by Australia and New Zealand immediately after the outbreak was identified, alongside support from the Global Fund.
However, he cautioned that Global Fund resources allocated to Fiji remain limited because funding is shared among 12 Pacific Island countries.
He said additional investments are urgently needed to expand prevention programmes, strengthen laboratory capacity, improve counselling services, undertake behavioural research and support communities most affected by HIV.
“We have many research questions that need answers, but the challenge is funding.”
Expressing hope that greater international attention could attract new research collaborations, Dr Mitchell added:
“Hopefully, through your article, you can highlight this need and people can come.”
As delegates at the 2026 International AIDS Conference continue calling for renewed global commitment to ending AIDS as a public health threat, Fiji’s experience offers a sobering reminder that the epidemic continues to evolve in different parts of the world.
For health experts gathered in Rio, the message is clear: treatment remains essential, but ending HIV will also require sustained prevention, harm reduction, stronger maternal health services, behavioural research, community engagement and integrated responses capable of addressing HIV and viral hepatitis together before both epidemics gain further ground across the Pacific.
