Fiji’s HIV instances surge resulting from bluetoothing, chemsex and needle-sharing

[ad_1] <img sizes="(min-width: 1280px) 50vw, (min-width: 1008px) 66vw, 96vw" srcset="https://ichef.bbci.co.uk/news/240/cpsprodpb/11fb/live/1d4988b0-9f6f-11f0-99d3-79886bca9dc5.jpg.webp 240w,https://ichef.bbci.co.uk/news/320/cpsprodpb/11fb/live/1d4988b0-9f6f-11f0-99d3-79886bca9dc5.jpg.webp 320w,https://ichef.bbci.co.uk/news/480/cpsprodpb/11fb/live/1d4988b0-9f6f-11f0-99d3-79886bca9dc5.jpg.webp 480w,https://ichef.bbci.co.uk/news/640/cpsprodpb/11fb/live/1d4988b0-9f6f-11f0-99d3-79886bca9dc5.jpg.webp 640w,https://ichef.bbci.co.uk/news/800/cpsprodpb/11fb/live/1d4988b0-9f6f-11f0-99d3-79886bca9dc5.jpg.webp 800w,https://ichef.bbci.co.uk/news/1024/cpsprodpb/11fb/live/1d4988b0-9f6f-11f0-99d3-79886bca9dc5.jpg.webp 1024w,https://ichef.bbci.co.uk/news/1536/cpsprodpb/11fb/live/1d4988b0-9f6f-11f0-99d3-79886bca9dc5.jpg.webp 1536w" src="https://ichef.bbci.co.uk/news/480/cpsprodpb/11fb/live/1d4988b0-9f6f-11f0-99d3-79886bca9dc5.jpg.webp" loading="eager" alt="Getty Images Three syringes, seemingly used, lying on a tattered orange blanket" class="sc-5340b511-0 bGQwLJ"/> Getty Pictures Intravenous drug use is fuelling Fiji's HIV epidemic

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 in every of hundreds of Fijians to have contracted the bloodborne virus lately – lots of them aged 19 or youthful, and plenty of of them by means of intravenous drug use.

"Extra younger individuals are utilizing medication," Ms Naitala, whose organisation offers assist to intercourse employees and drug customers within the Fijian capital Suva, tells the BBC. "He (the boy) was a kind of younger people who had 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 out to be the locus of one of many world's quickest rising HIV epidemics.

In 2014, the nation had fewer than 500 individuals dwelling 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 instances – a thirteenfold enhance on its normal five-year common. Of these, 41 had been aged 15 or youthful, in comparison with simply 11 in 2023.

<img sizes="(min-width: 1280px) 50vw, (min-width: 1008px) 66vw, 96vw" srcset="https://ichef.bbci.co.uk/news/240/cpsprodpb/7b4b/live/5dd4aa90-9f6f-11f0-9bc3-493c32f03408.jpg.webp 240w,https://ichef.bbci.co.uk/news/320/cpsprodpb/7b4b/live/5dd4aa90-9f6f-11f0-9bc3-493c32f03408.jpg.webp 320w,https://ichef.bbci.co.uk/news/480/cpsprodpb/7b4b/live/5dd4aa90-9f6f-11f0-9bc3-493c32f03408.jpg.webp 480w,https://ichef.bbci.co.uk/news/640/cpsprodpb/7b4b/live/5dd4aa90-9f6f-11f0-9bc3-493c32f03408.jpg.webp 640w,https://ichef.bbci.co.uk/news/800/cpsprodpb/7b4b/live/5dd4aa90-9f6f-11f0-9bc3-493c32f03408.jpg.webp 800w,https://ichef.bbci.co.uk/news/1024/cpsprodpb/7b4b/live/5dd4aa90-9f6f-11f0-9bc3-493c32f03408.jpg.webp 1024w,https://ichef.bbci.co.uk/news/1536/cpsprodpb/7b4b/live/5dd4aa90-9f6f-11f0-9bc3-493c32f03408.jpg.webp 1536w" src="https://ichef.bbci.co.uk/news/480/cpsprodpb/7b4b/live/5dd4aa90-9f6f-11f0-9bc3-493c32f03408.jpg.webp" loading="lazy" alt="Getty Images A view of the Suva waterfront, with a dock in the foreground and multi-storey buildings in the background" class="sc-5340b511-0 bGQwLJ"/> Getty Pictures Fiji's assistant well being minister has referred to as the HIV epidemic a "nationwide disaster"

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

"This can be a nationwide disaster," he mentioned. "And it's not slowing down."

The BBC spoke to a number of consultants, advocates and frontline employees concerning 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 identical time although, in addition they famous that numerous extra stay invisible to the official figures – and that the true scale of the problem is probably going a lot larger than even the record-breaking numbers counsel.

'Sharing the blood'

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

In any other case often called "hotspotting", this latter time period refers to a follow the place an intravenous drug person withdraws their blood after successful and injects it right into a second individual – who might then do the identical for a 3rd, and so forth.

Kalesi Volatabu, government director for the NGO Drug Free Fiji, has seen it occur firsthand. Final Might, she was on one in every of her common early morning walks by means of the Fijian capital of Suva, providing assist and schooling to drug customers on the streets, when she turned a nook and noticed a gaggle 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 girl, she'd already had the shot and he or she's taking out the blood – and then you definitely've received different women, 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 among the world's highest charges of HIV. In Fiji, the follow grew to become in style throughout the previous few years, in keeping with each Ms Volatabu and Ms Naitala.

<img sizes="(min-width: 1280px) 50vw, (min-width: 1008px) 66vw, 96vw" srcset="https://ichef.bbci.co.uk/news/240/cpsprodpb/de66/live/54020880-a007-11f0-b741-177e3e2c2fc7.jpg.webp 240w,https://ichef.bbci.co.uk/news/320/cpsprodpb/de66/live/54020880-a007-11f0-b741-177e3e2c2fc7.jpg.webp 320w,https://ichef.bbci.co.uk/news/480/cpsprodpb/de66/live/54020880-a007-11f0-b741-177e3e2c2fc7.jpg.webp 480w,https://ichef.bbci.co.uk/news/640/cpsprodpb/de66/live/54020880-a007-11f0-b741-177e3e2c2fc7.jpg.webp 640w,https://ichef.bbci.co.uk/news/800/cpsprodpb/de66/live/54020880-a007-11f0-b741-177e3e2c2fc7.jpg.webp 800w,https://ichef.bbci.co.uk/news/1024/cpsprodpb/de66/live/54020880-a007-11f0-b741-177e3e2c2fc7.jpg.webp 1024w,https://ichef.bbci.co.uk/news/1536/cpsprodpb/de66/live/54020880-a007-11f0-b741-177e3e2c2fc7.jpg.webp 1536w" src="https://ichef.bbci.co.uk/news/480/cpsprodpb/de66/live/54020880-a007-11f0-b741-177e3e2c2fc7.jpg.webp" loading="lazy" alt="Supplied: Kalesi Volatabu A woman in a black and turquoise dress, wearing glasses and speaking into a microphone in front of several onlookers. Behind her is a wall with several pieces of paper attached to it" class="sc-5340b511-0 bGQwLJ"/> Equipped: Kalesi Volatabu Kalesi Volatabu has spent greater than a decade working on the frontline of drug consciousness and advocacy in Fiji

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 return by in Fiji, the place pharmacies, underneath police strain, typically demand prescriptions for syringes, and there's a lack of needle-syringe programmes.

Though there's rising acceptance and approval for the rollout of such programmes – which offer clear injecting gear to drug customers in an try to scale back the transmission of blood-borne infections like HIV – implementation within the extremely non secular 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 Companies (MOH) recognised bluetoothing as one of many drivers for the nation's rise in HIV instances. One other was chemsex, the place individuals use medication - typically methamphetamine - earlier than and through sexual encounters.

In Fiji, not like most different nations world wide, crystal meth is predominantly consumed through intravenous injection.

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

Children on meth

Fiji has turn out to be a significant Pacific trafficking hub for crystal meth over the previous 15 years. A big a part of that is because of the nation's geographic location between East Asia and the Americas – among 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, creating right into a disaster that, like HIV, was lately declared a "nationwide emergency".

And in keeping 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 instances. Sexual transmission accounted for 47% of instances, whereas mother-to-child transmission throughout being pregnant and childbirth was cited as the reason for most paediatric instances.

Everybody the BBC spoke to agreed that lack of schooling is a central issue within the epidemic. Ms Volatabu and Ms Naitala are each working to alter that – and Ms Naitala says that as a larger 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 looking for therapy for HIV, resulting in extra sturdy information across the scale of the disaster.

However there's nonetheless a fear that the official case numbers are merely the tip of the iceberg – and a worry of what might lie beneath the floor.

The avalanche

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 reference to Fiji's HIV disaster – not simply what's occurring in the mean time, however the place it is going to be in three years' time and the dearth of Fiji's assets," he tells the BBC. "The assist techniques - the nursing, the flexibility to distribute or to entry the medication for therapy of HIV - simply aren't there.

"That is what terrifies us, the people who work within the area: there is no such thing as a method that Fiji can take care of this."

<img sizes="(min-width: 1280px) 50vw, (min-width: 1008px) 66vw, 96vw" srcset="https://ichef.bbci.co.uk/news/240/cpsprodpb/18f8/live/83b21860-9ffb-11f0-b741-177e3e2c2fc7.jpg.webp 240w,https://ichef.bbci.co.uk/news/320/cpsprodpb/18f8/live/83b21860-9ffb-11f0-b741-177e3e2c2fc7.jpg.webp 320w,https://ichef.bbci.co.uk/news/480/cpsprodpb/18f8/live/83b21860-9ffb-11f0-b741-177e3e2c2fc7.jpg.webp 480w,https://ichef.bbci.co.uk/news/640/cpsprodpb/18f8/live/83b21860-9ffb-11f0-b741-177e3e2c2fc7.jpg.webp 640w,https://ichef.bbci.co.uk/news/800/cpsprodpb/18f8/live/83b21860-9ffb-11f0-b741-177e3e2c2fc7.jpg.webp 800w,https://ichef.bbci.co.uk/news/1024/cpsprodpb/18f8/live/83b21860-9ffb-11f0-b741-177e3e2c2fc7.jpg.webp 1024w,https://ichef.bbci.co.uk/news/1536/cpsprodpb/18f8/live/83b21860-9ffb-11f0-b741-177e3e2c2fc7.jpg.webp 1536w" src="https://ichef.bbci.co.uk/news/480/cpsprodpb/18f8/live/83b21860-9ffb-11f0-b741-177e3e2c2fc7.jpg.webp" loading="lazy" alt="Supplied: José Sousa-Santos A man with a goatee wearing a blue suit and blue shirt" class="sc-5340b511-0 bGQwLJ"/> Equipped: José Sousa-Santos José Sousa-Santos has been ringing the alarm bell on Fiji's HIV epidemic for years

Following its declaration of an outbreak in January, the Fijian authorities has sought to enhance its HIV surveillance and improve its means to handle the probably underreporting of instances.

The International Alert and Response Community, which was referred to as upon to offer that assist, acknowledged in a latest report that "addressing these urgent points by means of 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 speedy checks and medicines had been impacting screening, prognosis and therapy.

Knowledge 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 consultants, authorities and on a regular basis Fijians at the hours of darkness. And Mr Sousa-Santos is predicting an "avalanche" of instances nonetheless to return.

"What we're seeing in the mean time is the start of the avalanche, however you'll be able to't cease it, as a result of the infections are already occurring 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 a few years," he says.

"There's nothing that we are able to do in the mean time to cease the variety of infections which have already occurred over the previous 12 months, and which might be occurring now. That is what's actually terrifying."