Fiji strengthens its HIV response through evidence-based harm reduction

Fiji is taking decisive steps to address a rapidly escalating HIV epidemic. In 2024, 1583 new HIV cases were reported nationally, while 1226 cases were notified in the first 6 months of 2025 alone. Among people starting HIV treatment in 2024, 48% were people who inject drugs, highlighting the disproportionate impact on this group. As new evidence highlights unsafe injecting drug use is a major driver of transmission and exposes urgent gaps in access to prevention and stigma-free care.

A joint rapid assessment commissioned by the World Health Organization (WHO) and the United Nations Development Programme (UNDP), and funded by The Global Fund, found that many people who inject drugs in Suva face syringe scarcity, unsafe injecting practices and fear of discrimination when seeking health services. The assessment was carried out on the request of Fiji’s Ministry of Health and Medical Services (MHMS) by the Kirby Institute at the University of New South Wales, Fiji National University and the Australian Injecting and Illicit Drug Users League. It underscores the urgent need for harm reduction interventions – particularly needle and syringe programmes (NSPs) – as part of a comprehensive public health response.

From evidence to implementation

To support national action, a two-day national workshop was held in Suva to apply the new WHO Operational guide for needle and syringe programmes for people who inject drugs to the Fijian context.

The workshop was convened and funded by the United Nations Population Fund (UNFPA), which served as the lead technical agency alongside the Kirby Institute at the University of New South Wales, in collaboration with the Ministry of Health and Medical Services, WHO, the Joint United Nations Programme on HIV/AIDS (UNAIDS), UNDP, and other partners. It brought together government officials, police, religious leaders, pharmacists, clinicians, civil society organizations, UN agencies, researchers and a community representative with lived experience of injecting drug use.

Participants worked through the guide’s 5 modules – assessment and planning, implementation models, comprehensive services, monitoring and sustainability – to explore practical options for designing and scaling needle and syringe programmes aligned with national policies and public health priorities.

“This process helped shift the focus from whether harm reduction is needed to how it can be implemented rapidly and effectively in Fiji,” said Dr Jason Mitchell, Chairperson for the National HIV Outbreak and Cluster Response Taskforce from the Fiji Ministry of Health and Medical Services.

“In the context of Fiji’s HIV situation, introducing NSP is essential to reducing transmission, protecting communities and linking people to health services that are safe, confidential and stigma-free,” said Dr Mark Jacobs, WHO Director of Pacific Technical Support and WHO Representative to the South Pacific. “I welcome the progress toward implementation of this critical programme, and WHO stands ready to support the Ministry of Health and Medical Services and partners to translate plans into action.”

Why needle and syringe programmes matter

NSPs have long been a core component of WHO-recommended harm reduction for people who inject drugs. Evidence from multiple settings show that NSPs significantly reduce HIV and hepatitis transmission, prevent injection-related infections and provide an entry point to broader health and social services – without increasing drug use.

Yet coverage remains inadequate in many countries, particularly where stigma, criminalization and limited resources restrict access.

“People who inject drugs are often left behind in HIV responses, despite facing some of the highest risks,” said Dr Tereza Kasaeva, Director of WHO’s Department for HIV, Tuberculosis, Hepatitis and Sexually Transmitted Infections. “The newly released WHO operational guide is designed to help countries translate evidence into practice – supporting needle and syringe programmes that are grounded in public health, human rights and the realities people face.”

Addressing stigma and building trust

A consistent theme throughout the workshop was the need to reduce stigma and ensure services are accessible, confidential and non-judgemental. Participants highlighted that fear of arrest, discrimination and breaches of confidentiality continue to deter people who inject drugs from accessing HIV testing, prevention and treatment.

Engagement of law enforcement and faith leaders was seen as a critical step toward building trust and aligning public health and community priorities.

“Preventing HIV is about protecting health and dignity,” noted a workshop participant, who requested to remain anonymous, from The Angels Collective, Fiji’s first peer education programme for people who inject drugs, funded by the Australian Department of Foreign Affairs and Trade. “If services are not safe or welcoming, people will not use them – no matter how strong the evidence is.”

A pathway forward

The workshop concluded with key next steps, including:

• developing a phased national approach to NSP implementation using the WHO operational guide;
• expanding low-threshold access points for the distribution of sterile injecting equipment through health services, pharmacies and outreach, including peer outreach;
• strengthening links between NSPs and HIV testing, treatment and other essential services;
• investing in training to reduce stigma among frontline health workers and other service providers; and
• ensuring meaningful involvement of people with lived experience in programme design and monitoring.

"To ensure the long-term sustainability of the Needle and Syringe Programme (NSP), UNFPA Pacific will provide critical funding and technical assistance to the Fiji Ministry of Health and Medical Services to conduct robust monitoring and evaluation of the NSP, enabling a data-driven assessment of the program’s impact in reducing HIV transmission rates," said Dr Titilola Duro-Aina, Chief of Health and Technical Advisor-SRHR, UNFPA Pacific.

Looking ahead

To address Fiji’s escalating HIV epidemic, the Ministry of Health and Medical Services, in collaboration with WHO, UNAIDS, UNDP, UNFPA and partners, is implementing a comprehensive HIV Surge Strategy (2024-2027) and a national HIV Outbreak Response Plan. Together, these efforts aim to expand comprehensive HIV testing and treatment, strengthen outreach to key populations, and accelerate the introduction of evidence-based harm reduction interventions, including NSPs.  

With the launch of the WHO operational guide in early 2026, Fiji’s experience demonstrates the relevance and timeliness of global guidance in supporting locally led, context-specific HIV responses across diverse settings.

As implementation progresses, sustained political commitment, coordinated action across sectors, a firm understanding of transmission dynamics across populations, and meaningful community engagement will be critical to expanding harm reduction services as part of a comprehensive HIV response – ensuring no one is left behind.