A rapid assessment of injecting drug use and HIV in Suva, Fiji

BACKGROUND: Following a rapid increase in HIV notifications, the Government of Fiji declared an HIV outbreak in 2025 and an HIV emergency 2026. Unsafe injecting practices among people who inject drugs were identified as a major route of transmission. Despite this, little is known about drug use, injecting practices and HIV risk in Fiji. This study aimed to assess knowledge, attitudes, beliefs and practices related to injecting drug use and associated HIV risk to inform the public health response​. METHODS: Using a participatory action research framework and informed by rapid assessment methods, trained peers conducted semi-structured interviews with 56 people who inject drugs in Suva (March - April 2025). Participants were recruited using purposive sampling. Interviews were transcribed verbatim and data analyzed using iterative categorisation. RESULTS: Methamphetamine was the most reported drug injected by study participants. Almost half reported injecting the first time they used methamphetamine. Access to sterile injecting equipment was limited with all participants reporting receptive needle/syringe sharing. Participants reported routinely being injected by others, repeatedly reusing needle/syringes, often for long periods of time, and other unsafe injecting practices. Participants also described using blood drawn into the barrel of the syringe from the injection site to mix the drug (termed "koda", or in English, "raw"). CONCLUSIONS: Needle/syringe scarcity, low knowledge about safer injecting, and unsafe injecting and drug preparation practices are increasing HIV risk in Fiji There is an urgent need to provide high coverage needle-syringe programs, implement peer-led interventions to improve awareness and reduce unsafe injecting practices.