Fiji, a small Pacific island nation, on Sept. 15 declared a national emergency as it confronted one of the sharpest increases in new HIV infections globally. 

The surge had been building for years, prompting the government to begin intensifying its response two years before the emergency declaration.

In 2024, the government adopted a four-year HIV Surge Strategy, covering 2024 through 2027, and later put in place a national plan to respond to the outbreak. UNAIDS and the World Health Organization have supported that effort.

The scale of the crisis is stark. 

An estimated 9,100 people were living with HIV in Fiji in 2025, according to UNAIDS — a 12-fold increase from 2010. HIV has no cure, but effective treatment can suppress the virus, allowing people living with HIV to live long, healthy lives, and preventing sexual transmission when the virus remains undetectable.

In announcing the emergency, Health and Medical Services Minister Ratu Atonio Lalabalavu said the country recorded 2,016 new HIV diagnoses in 2025, the highest annual total on record. He called the figures a sign of the “seriousness of the epidemic and the urgent, coordinated response our country now needs.”

The crisis is also affecting children. 

Save the Children Fiji said this week that a two-month-old baby is currently the youngest patient in the country living with both HIV and tuberculosis. The organization said 59 babies acquired HIV through mother-to-child transmission in 2025, while 67 new HIV cases were recorded among children under 15.

Five years ago, about one in every 167 people in Fiji was estimated to be living with HIV, according to government figures cited by the Associated Press. Since then, Fiji has also emerged as an important transit point in the regional drug trade, with international criminal networks moving narcotics from Latin America and Asia toward markets including Australia and New Zealand. Some of those drugs are also reaching Fiji’s domestic market, where injecting drug use has become an increasingly important route of HIV transmission.

Sexual transmission has continued to fuel the outbreak, with health officials pointing to inconsistent condom use and gaps in HIV testing. Stigma and misinformation have made the problem harder to confront, according to UNAIDS Pacific adviser Renata Ram, who has warned that limited knowledge about HIV can discourage people from seeking testing and care.

In a statement to the Washington Blade, Eamonn Murphy, UNAIDS’ regional director for Asia and the Pacific and Eastern Europe and Central Asia, cautioned against viewing Fiji’s epidemic through the lens of a single behavior or community. Among cases where the mode of transmission is known, he said, more than half are linked to sexual transmission and more than 42 percent to injecting drug use.

“The rise in infections among women and infants also shows that HIV has reached more widely across society,” Murphy said. “What stands out is how quickly the epidemic changed compared with the pace of the response. Access to PrEP and harm reduction remained limited, Fiji did not yet have a needle and syringe programme, and stigma and policy barriers continued to keep some people away from services.” 

Murphy noted only 39 percent of people with HIV in Fiji knew their status in 2025, and only 22 percent of them were receiving treatment. He also pointed out a wider system-level problem. 

“COVID-19 and the years that followed disrupted services, shifted attention and resources, and left community-led outreach operating below the scale that was increasingly needed,” said Murphy. “The epidemic moved faster than the response.”

Murphy said the immediate challenge is to bring HIV prevention and treatment closer together and make both easier to access at scale. He said PrEP, condoms, testing and harm reduction — including Fiji’s planned needle and syringe program — need to reach people earlier. At the same time, people diagnosed with HIV need a clear path into same-day treatment, care and support that helps them remain in treatment.

The tool at the center of the harm-reduction debate is hardly new. 

Needle and syringe programs provide people who inject drugs with sterile equipment, helping them avoid sharing needles and reducing the risk of HIV and other blood-borne infections. Decades of evidence have found that NSPs reduce HIV transmission without increasing drug use, and WHO describes them as a proven and cost-effective public health intervention. Such programs operate in more than 90 countries worldwide. Yet Fiji, even as injecting drug use has become an increasingly important route of HIV transmission, is only now moving toward introducing one.

“Trust is just as important as access,” Murphy told the Blade. “People most affected by HIV are more likely to use services when they are confidential, respectful and connected to organisations they already know. Community groups and peer workers are increasingly part of Fiji’s response, including the rollout of free PrEP, and that closer link with the health system can make a real difference.” 

“As UNAIDS has stated, the national crisis declaration is ‘a call for action, not fear,’” he added. “Fiji has the tools to change the trajectory; the priority now is to turn political commitment into rapid, coordinated action that reaches people at scale. The UN Joint Team is working to support the national response.”

Joeli Colati, executive director of Fiji Network Plus, a nongovernmental support and advocacy network established by and for people living with HIV, told the Blade that HIV affects people in ways that extend far beyond their health. Some people are afraid to get tested because they fear being judged or worry that others will discover their HIV status. Others fear the consequences for their families, jobs and relationships, as well as stigma and gossip. For LGBTQ people and other vulnerable populations, Colati said, those fears can be even harder to navigate because some already face discrimination. When people do not feel safe, he said, they may avoid testing, treatment and other HIV services.

Fiji does not have a reliable national count of its broader LGBTQ population. 

UNAIDS estimates that about 16,000 men who have sex with men and transgender people live in the country, though that figure should not be treated as an estimate of the entire LGBTQ community.

“We are also seeing a lot of HIV misinformation, especially on social media. This includes people sharing wrong information about how HIV is spread, how it is treated, and what it means to live with HIV,” said Colati. “Another serious concern is the increase in herbal healers claiming they can cure HIV. There is currently no cure for HIV. These claims can be dangerous if they make people stop or delay their HIV treatment. Herbal medicine should never be promoted as a replacement for antiretroviral therapy (ART).”

Colati said HIV peer counselors and NGO outreach workers are helping people at the community level, from supporting those newly diagnosed and helping them stay in care to reaching people who may not visit clinics, providing accurate information and connecting them with testing and treatment. He said people are often more comfortable seeking help from someone who understands what they are going through.

“As someone living with HIV myself for 19 years, I know that a person who is newly diagnosed needs more than medicine. They also need support, correct information and hope. With treatment, people living with HIV can live long and healthy lives,” Colati said. “We also need people to understand undetectable equals untransmittable, or U=U: when a person living with HIV takes treatment and maintains an undetectable viral load, they do not sexually transmit HIV. That is both a prevention message and a powerful message against stigma. Fiji Network Plus, the national network for people living with HIV, reinforced this message in our response to Fiji’s national HIV crisis.”

Asaeli Sinusetaki, acting chief executive of Rainbow Pride Foundation, an LGBTQ advocacy group based in Suva, the Fijian capital, in a statement to the Blade said the organization welcomed the government’s declaration because it showed officials now recognized the seriousness of the situation. 

“It is unfortunate that it took this long to respond, because the warning signs were always there,” Sinusetaki added.

“For LGBTQ+ people, experiences can differ depending on how comfortable they are accessing services,” Sinusetaki said. “At the same time, LGBTQ+ communities in Fiji have been one of the driving forces behind prevention efforts. Yes, accessing services independently can be a challenge because of fear, particularly stigma and discrimination. But because many LGBTQ people are also part of the Peer Outreach Worker network, they have established trust within their communities and networks to help people access information and services.”

Sinusetaki said access to HIV testing remains a major challenge, with testing unavailable at many local health centers, forcing some people to travel to sexual and reproductive health clinics or hospitals. He said that can be a significant barrier in a country where people often do not seek medical care unless they are already sick, making it unlikely that someone would make a separate trip simply to get an HIV test.

“The emergency has also highlighted that HIV cannot be treated as a stand-alone issue,” said Sinusetaki. “LGBTQ people need access to a broader package of sexual and reproductive health services, STI screening and treatment, mental health and psychosocial support, prevention information, condoms and lubricants, PrEP and PEP and, where relevant, harm-reduction services.” 

“For people who receive a positive diagnosis, the challenge does not end with testing,” Sinusetaki added. “We need to ensure that they are linked rapidly to treatment, supported to remain in care and treated with dignity throughout that journey.

The Blade reached out to Lalabalavu multiple times for comment, but did not receive a response.

UNITED NATIONS — U.N. High Commissioner for Human Rights Volker Türk on Monday said there is a “comprehensive onslaught” against LGBTQ and intersex rights around the world.

“We know that progress for human rights has never been linear … but today’s backlash is deep and it is coordinated and the persecution of LGBTIQ+ people around the world is escalating at an alarming rate,” he said during an U.N. LGBTI Core Group event that took place on the sidelines of the U.N. General Assembly.

The Core Group is a group of U.N. member states that have pledged to support LGBTQ and intersex rights.

Mexico and Norway are the current co-chairs. The U.S. withdrew from the Core Group shortly after the Trump-Vance administration took office in 2025.

“We know that across every region, LGBTIQ+ people continue to live and to love in the face of hostility and exclusion,” said Türk. “Their rights, safety, well-being are under attack … it’s a comprehensive onslaught.”

The event took place days after Turkish authorities carried out raids in Istanbul and in other cities across the country that targeted the country’s LGBTQ community.

Türk in his remarks specifically referenced Turkey and Senegal, which further criminalized consensual same-sex sexual relations earlier this year. He also noted some countries have deemed LGBTQ and intersex rights groups as “terrorists, extremists, or national security threats.”

The Trump-Vance administration’s anti-terrorism strategy that it released in May specifically references “radically pro-transgender” groups.

Türk noted “more and more candidates and political parties … use bigotry in order to promote anti-LGBTIQ+ sentiments” during election campaigns. He pointed out trans people and women are often targeted.

“These attacks are designed to confuse and to distract,” said Türk. “They cloak bigotry in the language of decency and morality. They evoke the protection of children against manufactured threats, while real and growing dangers to children’s lives and futures, including those linked to technology, to inequality and to the climate disaster remain unaddressed.”

“More broadly those who seek to erase difference and independent thought, expression, and voices from our societies often begin this by erasing LGBTIQ+ people from books and classrooms, from film and culture and from our streets,” he added. “So, this is always the beginning. It’s a wedge issue that unfortunately is used politically to erase other portions of society eventually.”

90 percent of LGBTQ, intersex groups have lost funding since 2025

The event took place less than two weeks after Outright International released a report that found 90 percent of LGBTQ and intersex rights groups around the world have lost funding since January 2025.

The Trump-Vance administration froze nearly all U.S. foreign aid shortly after it took office.

Secretary of State Marco Rubio in March 2025 announced 83 percent of U.S. Agency for International Development contacts had been cancelled, and the State Department would administer the remaining programs. USAID officially shut down on July 1, 2025.

Rubio issued a waiver that allowed PEPFAR and other “life-saving humanitarian assistance” programs to continue to operate during the funding freeze. The Washington Blade has previously reported PEPFAR-funded programs in Kenya and other African countries have been forced to suspend services and even shut down because of gaps in U.S. funding.

Dutch Foreign Trade and Development Cooperation Minister Sjoerd Sjoerdsma in his remarks at the Core Group event noted his government — openly gay Prime Minister Rob Jetten took office in February — will pledge €50 million ($57.29 million) to support LGBTQ groups around the world. British Under Secretary of State Chris Elmore pointed out his government has pledged £21 million ($28.05) from 2026-2029 to bolster LGBTQ and intersex rights around the world.

“Equality benefits everyone,” said Elmore.

(The British Supreme Court in 2025 ruled the legal definition of a woman is limited to “biological women” and does not include trans women.)

Mexican Foreign Affairs Secretary Roberto Velasco Álvarez, Norwegian International Development Minister Åsmund Aukrust, Icelandic Foreign Affairs Minister Þorgerður Katrín Gunnarsdóttir, Maltese Foreign and European Affairs Minister Chris Fearne, Brazil’s National Secretary for the Promotion and Defense of the Rights of LGBTQIA+ People Symmy Larrat, Irish State Minister for International Development and Diaspora Neale Richmond, South African Department of International Relations and Cooperation Director-General Zane Dangor, Uruguayan Multilateral Affairs Director María Noel Beretta, French Ambassador-at-Large for Human Rights Isabelle Rome, Cabo Verdean Permanent U.N. Representative Tania Romualdo, Estonian Department of International Organizations and Human Rights Director General Käthlin Saluveer, and Swedish International Development Cooperation Director-General Camilla Nevstad Bruzelius also spoke at the event that Outright International Executive Director Maria Sjödin moderated.

Other speakers included Jon Tilli of Deutsche Bank, UN Women Civil Society Division Director Lopa Banerjee and two activists: Gloria Quaye of Ghana and Nhuun Wannapong Yodmuang of Thailand.

Quaye was among the 21 people who Ghanaian authorities arrested in 2021 during a human rights workshop for LGBTQ activists. She was detained for three weeks until a court dropped the charges.

“In times of adversity, countries can often be tempted to turn inward at precisely the moment when international cooperation is needed the most,” said Sjödin. “The United Nations, of course, brings together sovereign states, but sovereignty cannot be used to decide whose rights count.”

Then-first lady Jill Biden in 2024 spoke at a Core Group event that took place on the sidelines of that year’s U.N. General Assembly. Then-Vice President Joe Biden in 2016 headlined the Core Group event that coincided with that year’s U.N. General Assembly.

The U.S. did not send any representatives to this year’s event.

Jessica Stern, the former special U.S. envoy for the promotion of LGBTQ and intersex rights under the Biden-Harris administration, and former U.S. Ambassador to Bosnia and Herzegovina Eric Nelson were among those from the U.S. who attended.

“The movement for the equal rights of LGBTIQ+ people has much to teach the world, particularly at this moment, but some seek to erase or reject those lessons,” said Türk. “The history of the movement for the equal rights is full of courage, dignity, and solidarity and it is an integral part of the human rights movement.”

“It’s not something separate; it’s an integral part of the full human rights movement,” he added. “In claiming their freedom, the LGBTIQ+ communities helped free our societies. We need to see it as a broader strive for freedom.”

A group of activists on Friday gathered in front of the Turkish Embassy in D.C. to protest the country’s anti-LGBTQ crackdown.

The protest — which the Council for Global Equality, Amnesty International USA, Outright International, and Health GAP organized — took place less than a week after Turkish authorities detained dozens of people during raids that targeted the country’s LGBTQ community and advocacy groups and HIV/AIDS service organizations.

Authorities in Istanbul on Sept. 15 detained more than 150 people who gathered outside a courthouse to protest the raids that are part of the government’s “My Family Is Safe” campaign. Journalists are among those who were taken into custody.

“This crackdown is not making families safer,” said Amnesty International USA Executive Director Nadia Daar, speaking in front of the Turkish Embassy.

Council for Global Equality Managing Director Keifer Buckingham stressed that “homosexuality is not a crime in Turkey.” Health GAP Executive Director Asia Russell and Outright International Senior Director of Law, Policy, and Research Neela Ghoshal also spoke.

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Activists in Madrid and in other cities around the world held similar protests on Friday.