Fiji's HIV crisis could spread across the region, health experts warn

Health experts are warning that Fiji's rapidly rising HIV infection rate - described as a "national crisis" - could spread across the Pacific if urgent action is not taken.

According to Dr Jalal Mohammed, a senior lecturer at the University of Canterbury and adjunct professor at the University of Fiji, the crisis has reached a "tipping point".

The Fijian Health Ministry has predicted more than 3000 new cases will be reported this year, but Dr Mohammed said that figure barely scratches the surface.

"In conservative societies, where there's a high stigma attached to the virus, there's going to be a significant number that goes unreported," he said.

"We've got estimates of about 45 percent [more]... so we're going to be looking at about 4500 to 5000 new cases this year. That is staggering for a small country."

With such high numbers, he said the rest of the Pacific is at risk.

"The region should be preparing for transmission of cases across borders. Fiji is a gateway country to other Pacific Islands. It is a major tourism hub. We're not going to be immune from what happens in Fiji.

"People going on holidays could pick up the virus. We could see an increased number of cases in New Zealand as well."

Dr Mohammed said the illicit drug trade is fuelling the surge in infections.

He said, as well as being a travel hub, Fiji's geographical location places it "at the heart of the drug trade super highway."

While most drugs brought into the country move through to Australia and New Zealand, they also flow into the domestic market, he said.

"That's driving it, because it is IV (intravenous) related. Intravenous needle sharing, there's chem-sex, bluetoothing. It is the increase of drug usage in Fiji that is predominantly spurring the increase in cases that we're seeing."

He said the practice of "bluetoothing", where one user takes drugs, then withdraws their blood and injects it into others, has become more common due to poverty and limited access to addiction services.

'Culture of silence, stigma'

Dr Sharon McLennan, a senior research fellow at Victoria University in Wellington, said a lack of education on how HIV and AIDS is spread is also an issue.

"We have a generation who've grown up with that culture of silence and stigma, not talking about it, also not hearing about it, through the health services, through the education services," she said.

"Many people don't understand how HIV is transmitted, they don't understand STDs (sexually transmitted diseases). And that's why we then see the rise of things like bluetoothing and people have no conception of the risk because they don't know how these how viruses are transmitted."

Alongside cultural stigmas and taboo, she said this gap in education is due to a lack of funding and resources.

She said the country's health system has been struggling to respond for years.

"Fiji has had a fairly unstable political history in the last few decades, and the health system suffered through a lot of that.

"If you've been to Fiji and been around the hospitals, the infrastructure is very old. It's not able to be well looked after. Staffing issues have been a problem over the years that are getting worse.

"We have a health system with limited capacity to address a crisis."

University of Fiji's head of nursing Professor Akisi Ravono said the response must include cultural and community leadership.

Professor Ravono said by involving the traditional vanua system, the community stigma can be overcome.

"We must incorporate traditional chiefs, the elders and the community leaders to get an effective HIV response running," HE SAID.

"These are the people who hold authority and influence within the indigenous Fijian communities... getting them to be educated on drugs and the risky behaviours, they can take that back to their communities and take responsibilities for the well being of their people."

She said empowering those leaders could help drive awareness in deeply conservative communities.

"It's considered as a taboo to talk about sex… that adds to the burden itself, so people are not aware of how they can get HIV, what are the modes of transmission."

Health leaders from 38 countries met in Fiji last week for the 76th session of the World Health Organisation Regional Committee for the Western Pacific.

A side conference focused on tackling HIV and AIDS across the region.

UNAIDS regional support teams director Eamonn Murphy said less than half of the people living with HIV in Fiji are receiving treatment.

Murphy said "epidemics are growing while donor investments fall".

"What story will we tell about HIV? Will the dream of ending AIDS by 2030 be realized, or will it fail at the foot of funding cuts and complacency.

"Although we know what to do, our efforts are not meeting the moment, just when targeted prevention programs for communities are most needed, support is dwindling... this could form the perfect storm that derails the goal of ending AIDS."

He said the region needs more sustainable funding to beat HIV and AIDS.

The WHO says it is vital that governments, civil societies and communities work together

It said a stigma and discrimination free environment is crucial to eradicate HIV and AIDS across the region.

Despite the grim statistics, all three experts share a collective hope.

"Fiji is quite a resilient country," Dr Mohammed said.

"There is a dedicated team of health professionals... they just need to have the resources to be able to do their jobs."

Ravono said success lies in the community itself: "With interventions engaging the vanua leaders, I think we have hope."

For Dr McLennan, it is Fiji's cultural strength that gives her confidence.

"Fiji has a strong culture... people are really well connected to each other, to the Vanua. This is a country where people stand together. They see a fight and they'll fight it together."