selective focus of negative and positive hiv blood sample test on red background Photo: Copyright: lightfieldstudios
As Fiji grapples with a growing HIV outbreak driven by a methamphetamine crisis, an expert warns the country could become a semi-narco state.
Six months after Fiji declared an HIV outbreak, driven largely by a growing methamphetamine crisis, UNAIDS' Pacific advisor says other countries around the region are at risk of following suit.
"It does worry me. We have all the risk factors in all the countries that could be another possible crisis like what's happening in Fiji," says Renata Ram, whose work covers 14 Pacific Islands countries.
She says testing of HIV around the Pacific Islands is poor, so they don't have a clear picture of the scale of the problem, but several countries including Solomon Islands, Vanuatu and Tonga have reported an increasing number of cases.
Fiji had 1583 new cases last year.
"This is the highest total that they've ever seen. It's a 281 percent increase from 2023," says Ram.
And while free, life-saving treatment is available, barriers including delays in receiving results, a mobile population, spread-out geography and a stigma about the disease all play in to a relatively low uptake of treatment.
Ram has been working for UNAIDS since 2017, and said the landscape had changed in that time.
"The HIV epidemic was largely driven by sexual transmission, however in early 2019 we started hearing sporadic cases of injecting drug use and domestic drug use, due to all this drug trafficking that was happening through Fiji."
One practice that had received a lot of attention and blame for spreading the virus is called 'bluetoothing", where after one person gets a hit, they withdraw their blood and share it with other people. It is a high-risk way of 'sharing' a high, which experts say does not work.
It comes with a high risk of contracting various blood-borne diseases, including HIV.
But Ram said this had been overblown.
"There's been a lot of sensationalisation around bluetoothing, but it's not the main way people who use drugs actually consume their drugs, it's a very small percentage of people who actually do this.
"Sharing needles is the main cause."
Ram said that, of the data they were able to get, about 48 percent of people in Fiji had contracted HIV through injecting drugs, compared to about 43 percent from sexual transmission. There were also 32 cases last year of mother-to-child transmission.
It is clear that behind the HIV crisis is a drug crisis.
Behind the drug crisis was a change in the way that drug trafficking through - and to - Fiji worked.
On today's episode of The Detail, an expert in transnational crime explains how drug trafficking through Fiji has changed in the past several years to depend more on local syndicates, and the effect this is having on Fiji's drug use and resulting HIV rates.
José Sousa-Santos, lead and convenor of the Pacific Regional Security Hub at the University of Canterbury, said drugs came through the Pacific Islands to New Zealand and Australia, which, despite being small markets, had some of the highest prices, due to tight control of the market.
But when local traffickers were paid in drugs instead of cash, they needed a local market to sell to.
"It's not the larger cartels that are looking at getting the local populations addicted, it's the smaller regional syndicates, the national syndicates, which can now really profit from these local markets.
"This creates 'foot soldiers' who help move drugs through.
"It leads us to see the roadmap toward Fiji in the future - if this is not addressed urgently - becoming a semi narco state ... where the syndicates and the cartels have undue and strong influence over the state itself and where the government will struggle to maintain law enforcement," he says.
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