The Pacific and HIV: A Chance to Turn the Tide Before Fiji's Epidemic Becomes a Wider Crisis

Fiji has declared a national HIV crisis, and the country's epidemic has drawn international attention in a way that recalls the early decades of AIDS: infections climbing fast, people staying away from clinics because of stigma, and health systems trying to catch up. In a commentary published on 27 October 2026, five senior United Nations officials argue that the Pacific can still keep this from becoming a much larger regional emergency.

The authors are Eamonn Murphy of UNAIDS, Dr Saia Ma'u Piukala of the World Health Organization's Western Pacific office, Pio Smith of UNFPA, Beate Trankmann of UNDP, and Delphine Schantz of UNODC. Their central point is that, unlike in the 1980s, effective treatment, new prevention tools and more than 40 years of experience now exist.

The numbers they cite are stark. New infections in Fiji rose roughly twelvefold between 2010 and 2025, making it one of the fastest-growing epidemics in the world. Papua New Guinea remains the region's largest, with an estimated 110,000 people living with HIV. Diagnoses have also risen recently in Palau, Solomon Islands and Vanuatu. Across the Pacific, new infections grew by an estimated 65 per cent over the same period, while they fell across Asia and the Pacific as a whole. In small countries, the authors note, even a modest number of new cases can signal a major shift.

They set out three lessons from the global AIDS response. The first is that HIV is everyone's concern. Early campaigns, they write, drew together doctors, politicians, faith leaders, police and people living with HIV, and led to changes in laws that fuelled stigma. They see Fiji's crisis declaration as an important political step because it acknowledges that the health sector cannot act alone. They also caution that measures such as mandatory testing or restrictive border controls risk repeating the discrimination of the past.

The second lesson is to let communities lead. Fear of judgement or unwanted disclosure can decide whether someone gets tested at all, and in small island and remote settings privacy is harder to protect. Community organisations and peer outreach workers build the trust that reaches people outside the health system. The authors say these services should be written into national HIV plans and budgets rather than depend on short-term donor projects, especially as external funding comes under pressure.

The third is closing the gap between scientific progress and access. Antiretroviral treatment lets people with HIV live long, healthy lives, and those who maintain an undetectable viral load do not transmit the virus sexually. Yet only about a quarter of people estimated to be living with HIV in Fiji, and about half in Papua New Guinea, are on treatment. In Papua New Guinea only about one in four pregnant women with HIV receive it, and an estimated 2,700 infants acquired HIV in 2024. The authors want testing and treatment built into routine antenatal, maternal and child health services, including in remote communities.

On prevention, they point to condoms, harm reduction, oral PrEP and twice-yearly injectable lenacapavir, which may suit people who struggle with a daily pill. In Fiji, where infections linked to injecting drug use are rising, recent legal changes have made a needle and syringe programme possible. They argue that new tools must reach Pacific countries sooner and at affordable prices, and that services should be integrated into primary health care rather than built as costly parallel systems, while keeping trusted community-led services. They also say prisons need attention, with continuity of care after release. Health worker shortages, the cost of reaching remote islands and climate-related disruption add to the strain.

The authors call for regional cooperation, including pooled procurement, stronger supply chains and shared expertise, through bodies such as the Pacific Community working with UNAIDS and its partner agencies. Only four years remain until 2030, the UN target for ending AIDS as a public health threat, and a UN political declaration adopted in June 2026 renewed commitments on prevention, treatment, rights, community leadership and financing. Whether Pacific governments fund community services and expand new prevention options in that time will shape the region's epidemics for years.