Male-to-male sexual transmission accounted for 144 reported HIV cases in Fiji last year, with young men aged 20 to 24 recording the highest number of cases, according to the Fiji HIV Surveillance Report 2025.
The report recorded 46 cases of male-to-male sexual transmission among those aged 20 to 24, followed by 37 cases among those aged 25 to 29.
Heterosexual transmission was also highest among people aged 20 to 24, with 102 cases reported.
Across all age groups, sexual transmission accounted for 430 cases, or 50.6 per cent of the 849 cases where a transmission route was identified.
Of these, 286 were attributed to heterosexual transmission and 144 to male-to-male sexual transmission.
Injecting drug use accounted for 362 cases, or 42.6 per cent of cases with a known transmission route, making it the largest single identified transmission category.
However, 1,167 reported HIV cases – 57.9 per cent of all cases – were classified as having an unknown mode of transmission.
The figures come as the Government called for a whole-of-society response to HIV after declaring it a national crisis, a year after declaring a national outbreak.
The 20 to 24-year age group recorded the highest number of cases associated with injecting drug use, at 131, followed by 70 cases among those aged 25 to 29 and 56 among those aged 30 to 34.
Mother-to-child transmission accounted for 57 cases, with 56 recorded among children aged four and under.
The report’s findings show that young adults in their 20s and early 30s accounted for a significant proportion of reported HIV transmission through both sexual activity and injecting drug use.
Assistant Minister for Health and Medical Services Penioni Ravunawa said the Government’s message remained one of prevention rather than stigma.
“HIV can be transmitted through certain infected body fluids, including blood, semen and vaginal fluids. It can also be transmitted through sharing contaminated needles and injecting equipment, and from mother to child during pregnancy, childbirth or breastfeeding,” he said.
“Our message is therefore one of prevention, testing, treatment and compassion – not stigma. Know your HIV status, practise safer sexual behaviour, never share needles or injecting equipment, and seek medical advice and treatment early.”
Minister for Health Dr Atonio Lalabalavu said the identified transmission modes showed the scope of testing carried out so far.
“The findings also show the seriousness of the epidemic and the gaps we must close in prevention, treatment and continuing care. An outbreak-level response is no longer sufficient; it requires co-ordinated action across Government, alongside communities and our partners,” he said.
Both have reiterated that with early diagnosis and appropriate treatment, people living with HIV can live long and healthy lives
Meanwhile, Fiji’s HIV crisis is worsening, but the Government will not make HIV testing mandatory for Fijians, with Health Minister Atonio Lalabalavu saying people must decide for themselves whether to get tested.
Dr Lalabalavu said mandatory testing was not an option under Fiji’s HIV Act.
“We’re not introducing HIV mandatory testing because it’s not under the HIV Act,” he said.
His comments come as Fiji faces a rapidly growing HIV epidemic, with Cabinet declaring the outbreak a national crisis last week.
Ministry of Health figures show Fiji recorded 2,016 new HIV diagnoses in 2025, up 27 per cent from 1,583 in 2024.
Health authorities have also warned that thousands of people are estimated to be living with HIV, highlighting the need for early testing, treatment and prevention.
The Ministry’s latest report said the increase in diagnoses reflects both rising transmission and improved detection through expanded testing and surveillance.
Dr Lalabalavu said HIV and tuberculosis were also closely linked, particularly when a person living with HIV was not receiving treatment.
“With HIV, someone who’s not on treatment, the immune system is down. Opportunistic infection would be commonly TB,” he said.
He said the Government’s HIV response would also include TB and Hepatitis C as part of a broader approach to tackling the crisis.
“We’re looking at it in a holistic view,” he said.
In another development, Fiji has sufficient supplies of sterile needles and syringes for a national harm-reduction programme, but their distribution is awaiting Government approval and amendments to legislation.
Minister for Health and Medical Services Dr Ratu Atonio Lalabalavu said the Cabinet sub-committee was working to have the programme approved by the next Parliament sitting on 28 September.
“We plan to have it endorsed in Cabinet and it will need some amendments to the legislation. Probably by the next sitting of Parliament, it should be approved,” he said.
National HIV Outbreak and Cluster Response Taskforce chair, Dr Jason Mitchell, said swift Government approval would allow the programme to be fully rolled out.
“The Fiji Government has procured all the needles and syringes and they’re currently sitting in our warehouse in Suva. We have sufficient supplies and we have engaged the services of UNDP who are able to procure additional resources if required, if we ever do run short.”
Dr Mitchell emphasised that the programme was aimed at encouraging “safer drug use”.
“From the public health side, our job is to make sure that people who are engaged in drug use are doing so safely and that they have access to sterile needles and syringes to reduce HIV infection and Hepatitis C that is currently rising as a result of risky behaviour associated with drug use.”
He said the Government had made its position clear on the distinction between drug use and supporting safer drug use.
“The industry is about supporting safe drug use. It is in no way saying that drug use is appropriate.”
Dr Mitchell said more than 90 countries around the world had adopted needle and syringe programmes, making sterile needles and syringes available to people who use drugs.
