Contributor:
Dr Jason Mitchell
HERO Awards Recipient: Health & Wellbeing Hero 2025
What is the HIV situation like in your country and region?
Fiji is in an acute, rapidly escalating HIV epidemic, with transmission now strongly linked to unsafe injecting practices alongside ongoing sexual transmission. Nationally, 1,583 new HIV cases were reported in 2024, and 1,226 were notified in the first six months of 2025.
Recent evidence also shows the epidemic is disproportionately affecting people who inject drugs, among people starting HIV treatment in 2024, 48% were people who inject drugs, signalling a serious concern for the rapid growth of infections within this community and its networks.
Across the wider Pacific, there are some countries who are showing early signs of a change in epidemic, with emerging evidence that there is a growing synthetic drug markets, popping up in various countries as we not with great concern, that just like Fiji in years past, programming did not evolve sufficiently to prevent this epidemic to take a grip on our population has it has in Fiji. We must do more to be responsive and not reactive.
What does People First mean to you in your community?
For me, People First means designing HIV services around real lives not around paperwork, fear, or moral judgement. In Fiji (and the Pacific), that looks like:
- Dignity and confidentiality as the default (services that feel safe to enter and safe to return to).
- Low-barrier access: practical hours, decentralised delivery, peer navigation, and simplified pathways to testing and treatment.
- Partnership with communities: community-led responses and talanoa-informed approaches that treat lived experience as expertise.
People First also means we stop defining people by behaviour or diagnosis. We start with: Who is this person, what do they need to be well, and what is blocking them from care?
How does stigma and discrimination prevent access to HIV services in Fiji and the Pacific?
Stigma and discrimination are not abstract concepts, they operate through institutions, social narratives, and everyday interactions. In Fiji’s current epidemic, they directly shape whether people test, disclose, initiate treatment, or remain in care.
At the individual level, people delay testing because they fear being seen at clinics, being labelled, or being reported. They may avoid disclosing risk behaviours to health workers, which limits accurate clinical care. Retention in treatment is compromised when interactions feel judgemental or unsafe.
However, stigma is also produced structurally and the media plays a critical role in this.
When reporting frames HIV, primarily as a consequence of “immoral behaviour” or focuses disproportionately on communities most affected, such as people who inject drugs, the narrative can unintentionally shift blame onto those communities. Sensationalised headlines or simplified storylines can:
- Reinforce moral judgement rather than public health understanding
- Portray specific groups as the “source” of the epidemic
- Amplify fear rather than empathy
- Publicly highlight communities that may otherwise live quietly and privately
In small island contexts like Fiji, where social networks are tight and anonymity is limited, this has magnified consequences. Media narratives can intensify stigma that might otherwise remain latent. They can also expose or “other” communities who may not have previously been publicly identified, increasing vulnerability to discrimination.
The result is predictable:
- People avoid services to protect themselves from being associated with public narratives.
- Communities withdraw from engagement with health programmes.
- Trust between affected populations and institutions weakens.
In this way, stigma is not just interpersonal it becomes systemic. And systemic stigma directly undermines outbreak control.
A People First approach therefore requires responsible, rights-based public communication. Media partners are not adversaries; they are essential public health actors. But the framing of the epidemic must centre dignity, structural drivers, and evidence, not blame.
Within the current political and funding climate, what can still be done to ensure access to services for marginalised populations?
Even in tight fiscal and political space, we can still do a lot because many high-impact actions are systems and service-design choices, not expensive new platforms:
- Scale harm reduction as public health: implement needle and syringe programmes with safe disposal, clear operating procedures, and strong community engagement, so people can prevent HIV today, not “after the debate is over”.
- Make testing and treatment genuinely low-barrier: same-day ART starts where appropriate, decentralised ART refills, differentiated service delivery, and peer-supported linkage.
- Protect confidentiality and reduce administrative burden: collect only what is necessary for care and programme improvement, and ensure staff are trained to uphold privacy.
- Integrate services (HIV, hepatitis, STIs, TB, mental health, and substance-use support) so people are not bounced between silos.
- Use “People First” accountability: track and publish practical indicators (waiting time, missed appointments, ART start time, stock stability, viral load coverage), and act quickly on where people fall out of care.
UN80 and the proposal to sunset UNAIDS — how will that affect Fiji/the region?
If UNAIDS is sunset or substantially reduced, Fiji and the Pacific risk losing a critical layer of the HIV response that is hard to replace quickly:
- Coordination and convening power across government, civil society, and donors, especially for key population programming and rights-based approaches.
- Strategic information and advocacy that helps countries translate data into political decisions and sustained financing.
- Continuity during a period of global funding stress, when the HIV response is already being disrupted in multiple settings.
It is also important to note: reporting indicates this is a proposal within the UN80 reform context, with governance decisions still subject to UN and UNAIDS processes.
Anything else you want to add and highlight?
Two things:
- We cannot “treat our way out” of an outbreak if people do not feel safe accessing services. People First is not a slogan it is outbreak control.
- Fiji’s situation is a warning and a lesson for the Pacific: when synthetic drugs expand rapidly and sterile equipment is scarce, HIV can surge faster than systems can adapt. The response must be fast, evidence-based, and grounded in dignity.
