SUVA, Fiji — On a bright afternoon in the Fiji capital, activist Mark Lal, 25, talks about loss in the past tense and survival in the present. Two of his closest friends are dead. The reason they contracted HIV, he says, traces back to a drug that has reshaped public health in his country in ways few would have predicted. "Two of my best friends passed away," Lal says. "The majority of my friends, they got HIV through crystal meth."
His homecoming of sorts came this past July, when Lal joined thousands of other delegates at the AIDS 2026 conference in Rio de Janeiro, where Fiji's crisis was placed on a global stage for the first time on such a scale.
The occasion was an unusual one. Fiji — long marketed as a tropical paradise and honeymoon destination — now carries the grim distinction of confronting two intertwined epidemics at once: HIV and addiction to methamphetamine. Between 2010 and 2025, the country's HIV case count rose roughly twelvefold, a trajectory that prompted Fiji's government to declare a national emergency in mid-September. Estimates put the number of people living with HIV in the country at upward of 9,000, and Fiji's health minister has said that roughly 1 in 60 adults is now affected.
Speaking at the Rio conference in July, Jason Mitchell, the public health specialist leading Fiji's HIV response, described the situation as the fastest-growing HIV epidemic anywhere in the world. The figure he singled out as most alarming is the age profile of those infected: two-thirds of cases are among people between 20 and 34.
"Our young, active, productive population is currently being infected with HIV, and unless we find solutions quickly, this will continue to get worse," Mitchell said.
That demographic warning matters because the years between 20 and 34 are precisely when most people are building careers, forming households and becoming economically independent. An epidemic concentrated there doesn't simply strain a health system; it erodes a country's future workforce and its capacity to care for people later in life.
The mechanism behind the surge is what distinguishes Fiji's epidemic from others. Transmission is not occurring primarily through sexual contact alone, but through the sharing of injection equipment linked to methamphetamine use. A large share of users inject the drug, and the resulting needle sharing has created a direct, efficient route for HIV to move through a population that may otherwise have had relatively limited exposure.
That connection was underscored by Mark Shaheel Lal, founder of the advocacy group Living Positive Fiji and a reconciliation officer for the Fiji Truth and Reconciliation Commission, who was also photographed at the Rio AIDS conference. "The majority of my friends, they got HIV through crystal meth," he said.
Geography has helped make the problem possible. Crystal meth has been available in Fiji to some degree for years, and the islands have long been known as a transit hub for the drug en route from South America toward its eventual destinations in Australia and New Zealand. What has changed, according to Fiji's HIV experts, is scale and reach. Since the COVID-19 pandemic, methamphetamine use in Fiji has soared, a surge experts attribute to a lethal combination of rising unemployment — which left young people with fewer economic options — and drugs that became ever easier to obtain.
"COVID was a difficult time for Fijians," one expert said, describing a period in which economic pressure, isolation and supply disruption compounded.
The declaration of a national emergency raises immediate questions about response. Emergency status typically unlocks additional funding, coordination and public messaging, and can accelerate access to testing and treatment. It also signals to donors and international partners that Fiji is no longer managing an ordinary public health challenge but a crisis requiring outside partnership — something that matters all the more for a country whose health system must stretch to serve a dispersed island population.
Public health officials have long warned that harm reduction, testing and treatment are the tools that can break the link between methamphetamine use and blood-borne transmission. But advocates note that the stigma attached to stimulant use keeps people away from clinics and testing centers, allowing infections to go undiagnosed for years.
For activists like Lal, the crisis is personal rather than statistical. His testimony — delivered to an international audience in Brazil — is intended to shift the conversation from blame to prevention, and to make clear that the epidemic's victims are young Fijians with futures that have been cut short.
Mitchell's assessment at AIDS 2026 was blunt: the trend is moving in the wrong direction, and the window for reversing it is narrowing. With two-thirds of infections concentrated among 20- to 34-year-olds and methamphetamine use still rising, Fiji's declared emergency reflects a compounding problem — a public health emergency layered on top of an economic and social crisis. The world's fastest-growing HIV epidemic is unfolding in a place once known chiefly as a paradise, and the people most affected say time is running out.
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