HIV infections are rising in 21 countries, including Sri Lanka, as Fiji declares a national emergency amid unsafe injecting and treatment gaps.
COLOMBO — Sri Lanka is among 21 countries where new HIV infections have increased substantially since 2010, according to the latest UNAIDS assessment, as a dramatic epidemic in Fiji demonstrates how quickly earlier gains against the virus can be reversed.
UNAIDS reported in July that 1.2 million people acquired HIV worldwide in 2025 and that new infections were increasing in three regions and 21 countries.
Sri Lanka appears on the organisation’s list of countries where new HIV infections increased by more than 20 per cent between 2010 and 2025.
The warning comes as Fiji formally declared HIV a national emergency on September 15 after experiencing one of the sharpest increases in new infections anywhere in the world.
Fijian authorities estimate that one in every 60 adults is now living with HIV, compared with approximately one in 167 five years earlier.
UNAIDS estimates that about 9,100 people were living with HIV in Fiji in 2025. Only 39 per cent knew their status and just 22 per cent were receiving antiretroviral treatment.
Those figures underline a central lesson from the epidemic: HIV can remain contained for years and then accelerate rapidly when prevention, testing, treatment and harm-reduction systems fail to reach vulnerable communities.
Fiji’s HIV Emergency
Fiji recorded 2,016 new HIV diagnoses in 2025, according to its Ministry of Health, representing a dramatic increase from the levels recorded only a few years earlier.
UNAIDS estimates that new infections in the Pacific island nation increased approximately twelvefold between 2010 and 2025.
Unsafe injecting practices associated with growing methamphetamine use have become an important part of the crisis, alongside sexual transmission.
One practice receiving particular attention is known as “bluetoothing”.
It involves a person injecting a drug and then drawing blood back into a syringe. That blood may subsequently be injected into another person, based on the belief that residual drug in the bloodstream can reproduce or prolong the drug’s effects.
The practice is associated with people attempting to share limited quantities of drugs and has been linked in reports to poverty and the lack of access to sterile injecting equipment.
Because blood is transferred directly between individuals, the potential for transmitting blood-borne infections is exceptionally serious.
Evidence on ‘Bluetoothing’ Requires Caution
Although bluetoothing has received widespread attention in reporting on Fiji’s HIV crisis, the available evidence suggests it should not be portrayed as the principal explanation for the epidemic without qualification.
A rapid assessment commissioned by the World Health Organization and United Nations Development Programme interviewed 56 people who inject drugs in Suva.
Only two participants reported personally engaging in bluetoothing, while another four said they had directly witnessed it.
Researchers therefore found relatively little evidence that the specific practice was widespread.
What they did identify as common was the sharing and reuse of needles, syringes and drug-preparation equipment.
Those practices alone create substantial risks for transmitting HIV, hepatitis and other infections.
The distinction matters.
Fiji’s epidemic cannot accurately be attributed to one unusual method of drug use. The broader problem involves unsafe injecting, inadequate access to sterile equipment, limited testing, low treatment coverage, stigma and barriers to healthcare.
Why Blood Sharing Is So Dangerous
HIV can be transmitted when blood containing the virus enters another person’s bloodstream.
Sharing needles and syringes is therefore among the most efficient routes through which HIV can spread.
Direct blood sharing creates an even more obvious pathway.
The danger is not confined to HIV.
People sharing contaminated injecting equipment can also be exposed to hepatitis B, hepatitis C and serious bacterial infections.
A lack of access to sterile equipment makes these risks considerably worse.
Fiji’s rapid assessment found that all participants interviewed had, at some point, reused a needle or syringe after another person because sterile equipment was not readily available.
Health authorities have consequently placed harm reduction, including a needle and syringe programme, among the measures required to bring the epidemic under control.
Community Workers Had Raised the Alarm
Kalesi Volatabu, Executive Director of Drug Free Fiji, has been among those warning publicly about dangerous injecting practices.
“How many more lives must we lose before we actually do something?” she asked while describing the scale of the problem.
Volatabu told the BBC World Service that she had personally witnessed groups waiting to receive blood after another person had injected drugs.
“About five or six people were standing there ready to receive that injection,” she said.
Her experience illustrates why frontline organisations remain concerned even though researchers have not established bluetoothing as a widespread practice throughout Fiji.
Stigma presents another obstacle.
People who inject drugs may be unwilling to disclose their behaviour, seek testing or approach health services because they fear social judgment or legal consequences.
That makes outbreaks more difficult to detect and control.
HIV Remains a Major Global Health Challenge
Globally, approximately 41 million people were living with HIV at the end of 2025.
An estimated 1.2 million people acquired the virus during the year, while approximately 570,000 died from HIV-related illnesses.
Those figures remain serious, but they also demonstrate how much progress has been achieved since the worst years of the epidemic.
Worldwide HIV-related mortality has fallen dramatically from its peak in the mid-2000s.
Modern antiretroviral therapy has transformed HIV from an infection that was once frequently fatal into a manageable chronic condition for people who are diagnosed and remain on effective treatment.
Treatment suppresses the amount of virus in the blood.
When a person receiving antiretroviral therapy achieves and maintains an undetectable viral load, HIV is not sexually transmitted. This principle is widely known as U=U, or “Undetectable = Untransmittable”.
The challenge is ensuring that people know their status and can obtain and remain on treatment.
How HIV Is Transmitted
HIV attacks cells in the immune system and, without treatment, progressively weakens the body’s ability to fight infections and disease.
Transmission can occur through infected blood, semen, vaginal fluids and breast milk.
The most common routes include:
- Sexual intercourse without effective protection or prevention
- Sharing contaminated needles and injecting equipment
- Mother-to-child transmission during pregnancy, childbirth or breastfeeding
- Exposure to infected blood in circumstances where proper medical precautions are absent
HIV is not spread through ordinary social contact such as touching, hugging, sharing food, using the same toilet or being near a person living with the virus.
AIDS, or Acquired Immunodeficiency Syndrome, describes the advanced stage of HIV infection when the immune system has been severely damaged.
Effective treatment can prevent HIV from progressing to AIDS.
Sri Lanka Appears on UNAIDS Warning List
Sri Lanka’s inclusion among the 21 countries with increasing new HIV infections deserves attention.
The UNAIDS 2026 assessment compares infection trends between 2010 and 2025 and identifies countries where new infections increased by more than 20 per cent.
The list includes Sri Lanka alongside countries such as Afghanistan, Algeria, Armenia, Bangladesh, Brazil, Congo, Costa Rica, Egypt, Kyrgyzstan, Madagascar, Niger, Pakistan, Paraguay, Peru, the Philippines, Senegal, Sudan, Tunisia and Venezuela.
This is different from saying Sri Lanka is experiencing an epidemic on the scale of Fiji.
The countries have different population sizes, prevalence rates, health systems and transmission patterns.
Sri Lanka’s inclusion nevertheless indicates that its trajectory is moving in the wrong direction at a time when many countries have achieved major reductions.
That makes prevention, early diagnosis, treatment access and public awareness increasingly important.
Similar Blood-Sharing Practices Have Been Reported Elsewhere
Bluetoothing is not unique to Fiji.
Research has documented comparable behaviour among some people who inject drugs in South Africa.
A related practice known as “flashblood” was previously reported among female injecting drug users in Dar es Salaam, Tanzania.
In flashblooding, blood is drawn from a person shortly after that person injects heroin and is then injected by another individual who believes that enough of the drug remains in the blood to reduce withdrawal or produce an effect.
A study involving 169 women who injected drugs in Tanzania found that 28, or approximately 17 per cent, reported having engaged in flashblood use.
Research in South Africa has similarly documented direct blood injection among a minority of people who inject drugs.
These practices are extremely dangerous, but existing evidence does not support describing them as a broad global trend.
Their significance lies in what they reveal about extreme-risk behaviour in settings affected by poverty, addiction and inadequate access to harm-reduction services.
Global HIV Funding Is Under Pressure
Another concern is the weakening of international financing for HIV prevention and treatment.
UNAIDS has warned that major reductions in international assistance could reverse decades of progress.
Its projections have suggested that funding disruptions could contribute to millions of additional HIV infections and millions of preventable AIDS-related deaths if essential services are not restored or replaced.
In May 2025, UNAIDS estimated that severe funding cuts could result in an additional six million HIV infections and four million preventable AIDS-related deaths over the following years.
The threat is particularly severe in countries where testing, antiretroviral medication, prevention programmes and community outreach have depended heavily on international assistance.
Fiji Offers a Warning Beyond the Pacific
Fiji’s experience demonstrates why countries cannot assume that earlier success against HIV guarantees permanent control.
An epidemic can accelerate when several vulnerabilities converge: unsafe injecting, drug dependency, stigma, inadequate prevention, low testing rates and weak treatment coverage.
Sri Lanka does not face an identical situation.
But its appearance on UNAIDS’ list of countries with rising infections means complacency would be risky.
Health authorities need accurate surveillance, accessible testing, effective sexual-health education, uninterrupted treatment and targeted prevention for populations at greater risk.
People who inject drugs also need evidence-based interventions capable of reducing transmission rather than policies that push them further from healthcare.
The lesson from Fiji is not simply about bluetoothing.
It is that unusual and dangerous behaviours become far more damaging when they occur within an environment where sterile equipment, treatment, information and trusted healthcare are difficult to obtain.
With 41 million people still living with HIV worldwide, the progress achieved over four decades remains substantial but unfinished.
For Sri Lanka, the warning contained in the latest UNAIDS figures is therefore straightforward: rising infections should be confronted while the numbers remain manageable, rather than after the trend develops into a far more difficult public-health emergency.
