AFP via Getty ImagesDelegates attending the Pacific HIV Symposium in Fiji next week will be confronting one of the region’s most urgent health challenges: the fastest growing HIV outbreak in the world. HIV prevalence among adults in Fiji is now 1.6%. This means about one in 60 adults lives with the virus. This is likely the tip of the iceberg: just one-third of people living with HIV in Fiji know their status, and only a quarter are receiving treatment. Experts project yearly infections will triple by 2030. Sadly, the equivalent of one child every week is born with HIV in Fiji, while one dies of AIDS-related complications every month.This is a public health emergency whose causes and consequences extend well beyond Fiji’s islands. In a region connected by travel, work, study and family ties, the challenge demands attention, support and informed engagement from its neighbours.An outbreak with many causesThe crisis is already gaining international attention, with Fiji in the spotlight at the AIDS2026 conference in Rio de Janeiro in July. The head of Fiji’s national HIV outbreak cluster response task force, Jason Mitchell, told delegates:It’s important to talk about what’s happening in Fiji, as it can happen anywhere in the world.No single factor explains the outbreak.Health authorities and experts point to a combination of rising methamphetamine use and needle sharing, disruptions to funding for prevention and treatment services, health system pressures and a culture of silence and stigma surrounding HIV. Since declaring the outbreak in January 2025, Fiji has established a dedicated HIV response task force and expanded testing and treatment. There is increasing emphasis on prevention tools. PrEP (pre-exposure prophylaxis), a highly effective medicine taken to prevent HIV, is now available. Fiji is now also in the queue for the long-acting HIV prevention drug Lenacapavir, as the Global Fund – a worldwide partnership to defeat AIDS, tuberculosis and malaria – expands access.Fiji is also working with international partners to strengthen its response. Australia recently announced a contribution of more than US$10 million to support Fiji’s HIV response. UNAIDS, the World Health Organization and many other international agencies are providing financial, technical and on-the-ground support. Why this matters beyond FijiDespite this progress, Fiji’s outbreak represents a significant health security risk to the region. Many New Zealanders and Australians have close connections to Fiji through tourism, seasonal employment, education and family networks. Fiji is also a major regional hub, connecting communities across the wider Pacific. This does not mean travellers should be alarmed. HIV is not transmitted through casual contact or everyday social interactions. Just as importantly, it is no longer the death sentence it was once perceived to be. With early diagnosis and effective treatment, it is managed as a chronic health condition, and people living with HIV can expect to live long, healthy lives.Understanding the situation in Fiji is not about avoiding travel. It is about encouraging informed and responsible behaviour (including condom use), access to HIV prevention tools and regular testing for those who may have been exposed to risk. Such precautions are relevant whether someone is travelling to Fiji, Auckland, Sydney or anywhere else. HIV is a global health issue, not a uniquely Fijian one.But one of the greatest challenges facing the response is social stigma, which research shows discourages people from testing, delays treatment and undermines public health efforts. A regional response is vitalConcerns about confidentiality, shame and discrimination can make it difficult for people to seek support, particularly in smaller and more closely connected communities. Similar barriers can affect Fijian health professionals diagnosed with HIV, as well as Pacific peoples living in New Zealand and Australia.This is why culturally safe services that recognise the realities of Pacific communities and reflect Pacific values are so important for supporting confidentiality and trust. Similarly, health authorities in New Zealand and Australia prioritise their own domestic preparedness and security in an outbreak so close to home. But these measures also need to avoid creating further stigma. Public health challenges in the Pacific – be they caused by HIV, other infectious diseases or climate change – are increasingly regional in nature. Fiji cannot do this alone and is still calling for support, funding and technical and capacity-building assistance. It is hoped this week’s Pacific HIV Symposium can build on what has already been offered and help the country’s health workers, community leaders and people living with HIV to confront this urgent challenge.Sharon McLennan receives funding from Te Apārangi the Royal Society of New Zealand.