Fiji’s HIV cases surge due to bluetoothing, chemsex and needle-sharing

Ten: that is the age of the youngest individual with HIV that Sesenieli Naitala has ever met.

When she first began Fiji’s Survivor Advocacy Community in 2013, that younger boy was but to be born. Now he’s one among hundreds of Fijians to have contracted the bloodborne virus lately – a lot of them aged 19 or youthful, and plenty of of them by intravenous drug use.

“Extra younger individuals are utilizing medication,” Ms Naitala, whose organisation gives help to intercourse staff and drug customers within the Fijian capital Suva, tells the BBC. “He (the boy) was a type of younger folks that have been sharing needles on the road throughout Covid.”

Over the previous 5 years, Fiji – a tiny South Pacific nation with a inhabitants of lower than one million – has turn into the locus of one of many world’s quickest rising HIV epidemics.

In 2014, the nation had fewer than 500 individuals residing with HIV. By 2024 that quantity had soared to roughly 5,900 – an elevenfold leap.

That very same 12 months, Fiji recorded 1,583 new circumstances – a thirteenfold improve on its regular five-year common. Of these, 41 have been aged 15 or youthful, in comparison with simply 11 in 2023.

Such figures prompted the nation’s minister for well being and medical providers to declare an HIV outbreak in January. Final week, assistant well being minister Penioni Ravunawa warned Fiji might document greater than 3,000 new HIV circumstances by the top of 2025.

“It is a nationwide disaster,” he stated. “And it isn’t slowing down.”

The BBC spoke to a number of specialists, advocates and frontline staff in regards to the causes for such a meteoric rise in case numbers. A number of identified that, as consciousness round HIV spreads and stigma diminishes, extra individuals have been coming ahead and getting examined.

On the similar time although, in addition they famous that numerous extra stay invisible to the official figures – and that the true scale of the difficulty is probably going a lot greater than even the record-breaking numbers counsel.

Underpinning Fiji’s HIV epidemic is a spiralling development of drug use, unsafe intercourse, needle sharing and “bluetoothing”.

In any other case generally known as “hotspotting”, this latter time period refers to a observe the place an intravenous drug person withdraws their blood after a success and injects it right into a second individual – who might then do the identical for a 3rd, and so forth.

Kalesi Volatabu, govt director for the NGO Drug Free Fiji, has seen it occur firsthand. Final Might, she was on one among her common early morning walks by the Fijian capital of Suva, providing help and training to drug customers on the streets, when she turned a nook and noticed a bunch of seven or eight individuals huddling collectively.

“I noticed the needle with the blood – it was proper there in entrance of me,” she recollects. “This younger lady, she’d already had the shot and he or she’s taking out the blood – and then you definitely’ve bought different ladies, different adults, already lining as much as be hit with this factor.

“It isn’t simply needles they’re sharing – they’re sharing the blood.”

Bluetoothing has additionally been reported in South Africa and Lesotho, two nations with a number of the world’s highest charges of HIV. In Fiji, the observe grew to become fashionable inside the previous few years, in line with each Ms Volatabu and Ms Naitala.

One motive for its enchantment, they clarify, is a less expensive excessive: a number of individuals can chip in for a single hit and share it amongst themselves. One other is the comfort of solely needing one syringe.

These could be troublesome to come back by in Fiji, the place pharmacies, underneath police stress, typically demand prescriptions for syringes, and there’s a lack of needle-syringe programmes.

Though there may be rising acceptance and approval for the rollout of such programmes – which offer clear injecting gear to drug customers in an try to cut back the transmission of blood-borne infections like HIV – implementation within the extremely spiritual and conservative nation has confirmed difficult.

Ms Volatabu says there’s a “drastic scarcity” of needle-syringe websites, which is fuelling harmful practices like needle-sharing and bluetoothing and placing the onus on NGOs to distribute syringes in addition to condoms.

In August 2024, Fiji’s Ministry of Well being and Medical Providers (MOH) recognised bluetoothing as one of many drivers for the nation’s rise in HIV circumstances. One other was chemsex, the place individuals use medication – typically methamphetamine – earlier than and through sexual encounters.

In Fiji, in contrast to most different nations world wide, crystal meth is predominantly consumed through intravenous injection.

MOH additionally discovered that of the 1,093 new circumstances recorded within the first 9 months of 2024, 223 – about 20% – have been from intravenous drug use.

Fiji has turn into a significant Pacific trafficking hub for crystal meth over the previous 15 years. A big a part of that is as a result of nation’s geographic location between East Asia and the Americas – a number of the world’s largest producers of the drug – and Australia and New Zealand – the world’s highest-paying markets.

Throughout that very same interval, meth has spilled into and unfold all through native communities, growing right into a disaster that, like HIV, was not too long ago declared a “nationwide emergency”.

And in line with these on the frontlines, the age of customers is trending downwards.

“We see an increasing number of of those younger individuals,” says Ms Volatabu. “They’re getting youthful and youthful.”

Fiji’s most up-to-date nationwide HIV statistics cite injectable drug use as the commonest recognized mode of transmission, accounting for 48% of circumstances. Sexual transmission accounted for 47% of circumstances, whereas mother-to-child transmission throughout being pregnant and childbirth was cited as the reason for most paediatric circumstances.

Everybody the BBC spoke to agreed that lack of training is a central issue within the epidemic. Ms Volatabu and Ms Naitala are each working to vary that – and Ms Naitala says that as a better consciousness across the risks of HIV spreads all through the group, “bluetoothing” has, in her expertise, fallen out of favour.

Extra individuals are getting examined and in search of therapy for HIV, resulting in extra strong information across the scale of the disaster.

However there may be nonetheless a fear that the official case numbers are merely the tip of the iceberg – and a concern of what might lie beneath the floor.

José Sousa-Santos, head of the Pacific Regional Safety Hub at New Zealand’s College of Canterbury, says “an ideal storm is brewing”.

“The priority is throughout all ranges of society and authorities with regard to Fiji’s HIV disaster – not simply what’s taking place for the time being, however the place it is going to be in three years’ time and the shortage of Fiji’s assets,” he tells the BBC. “The help techniques – the nursing, the power to distribute or to entry the medication for therapy of HIV – simply aren’t there.

“That is what terrifies us, the folks that work within the area: there isn’t any means that Fiji can take care of this.”

Following its declaration of an outbreak in January, the Fijian authorities has sought to enhance its HIV surveillance and improve its skill to handle the seemingly underreporting of circumstances.

The International Alert and Response Community, which was known as upon to supply that help, acknowledged in a current report that “addressing these urgent points by a well-coordinated nationwide response is essential in reversing the trajectory of the HIV epidemic in Fiji”.

That report additionally famous that staffing shortages, communication points, challenges with lab gear and stockouts of HIV fast assessments and medicines have been impacting screening, analysis and therapy.

Information assortment is sluggish, troublesome and error-prone, it added – hampering efforts to grasp the extent of Fiji’s HIV epidemic and the efficacy of the outbreak response.

That leaves many specialists, authorities and on a regular basis Fijians at the hours of darkness. And Mr Sousa-Santos is predicting an “avalanche” of circumstances nonetheless to come back.

“What we’re seeing for the time being is the start of the avalanche, however you possibly can’t cease it, as a result of the infections are already taking place now, or they’ve already occurred – we’re simply not going to have the ability to see them and folks aren’t going to look to get examined for an additional two to 3 years,” he says.

“There’s nothing that we are able to do for the time being to cease the variety of infections which have already occurred over the previous 12 months, and which can be taking place now. That is what’s actually terrifying.”