Global efforts, driven by public health campaigns and modern antiretroviral therapies, have steadily reduced new HIV infections around the world. However, this progress remains remarkably fragile, as shifts in illicit drug trading, social stigma and healthcare gaps can quickly unravel decades of medical advancements. As CNN reports, a clear example unfolded when Fiji declared a national public health emergency, revealing that approximately 1 in 60 adults in the island nation of under one million people is now living with HIV.
The situation has escalated dramatically over a short period. Health Minister Dr. Atonio Lalabalavu reported that Fiji recorded 2,016 new cases in 2025 alone, marking a sharp jump from a prevalence rate of 1 in 167 just five years prior. Compounding the crisis, the virus has increasingly impacted maternal and infant health, leaving dozens of babies infected perinatally. Health officials attribute this sudden surge to a mix of factors, including Fiji’s position along methamphetamine transit routes, frequent needle sharing, low usage of barrier contraceptives and persistent social stigma that deters people from seeking help.
What is HIV?
Human Immunodeficiency Virus (HIV) is a single-stranded RNA lentivirus, an enveloped retrovirus. HIV was first identified in the early 1980s and has two main viral strains: HIV-1, responsible for the vast majority of cases worldwide, found to be highly virulent, and HIV-2, confined to West Africa, which has a slower rate of progression, according to a PMC publication.
The World Health Organization (WHO) estimates that currently about 41 million people worldwide are living with HIV. Around the world, major progress has been made to get more people on ART, about 78 percent of people living with HIV.
By contrast, regional hotspots in the midst of sudden epidemics, such as Fiji, often fall significantly short, with UNAIDS estimating that fewer than 22% of people living with the virus are currently on treatment and only 39% are aware of their HIV status, the BBC reports. The surge in synthetic drugs, especially illegal methamphetamine, has created perilous needle-sharing systems along Pacific transit routes, creating a growing infectious disease crisis.
What’s happening in your body
After gaining entry into the bloodstream via infected bodily fluids, HIV specifically attacks cells that express the CD4 surface glycoprotein, mainly CD4-positive T lymphocytes, macrophages, and dendritic cells.
The virus uses the envelope glycoprotein 120 (gp120) to bind to the CD4 receptor and a coreceptor (usually CCR5 or CXCR4) of the cell. Once bound, the viral envelope fuses with the host cell membrane, releasing the viral capsid, genome (RNA), and enzymes into the host cell cytoplasm.
The virus copies its viral RNA into double-stranded complementary DNA by its own enzyme, reverse transcriptase. A second viral enzyme, integrase, shuttles this brand-new DNA into the host cell’s nucleus and embeds it in the host’s genomic DNA.
The viral genetic code becomes part of the host cell’s code, and the CD4 cell becomes a factory that transcribes and translates the virus’s proteins. The viral protease enzyme then processes the newly synthesized protein chains into functional pieces. These pieces polymerize at the cell membrane, and new infectious virions bud off.
The overall CD4 count gradually decreases as host CD4 cells are progressively lost through viral budding, cell exhaustion and programmed cell death (apoptosis). A healthy adult has 500-1500 CD4 cells in a microliter of blood; once the CD4 count drops below 200 cells/microliter, the individual progresses into the clinical phase of AIDS and experiences a high degree of immunodeficiency.
Which country is No. 1 in HIV?
South Africa is number one in the world in terms of the absolute number of people infected with the virus.
The official epidemiological statistics according to the National Institutes of Health (NIH) indicate that South Africa has about 7.8 million people who are infected with HIV. The country also has the world’s biggest public, ARV-based treatment program, with life expectancy stabilized and AIDS-related deaths reduced significantly over the last 20 years.
Eswatini (formerly Swaziland) has the world’s highest adult prevalence rate, or the percentage of adults living with HIV, at over 25%. Although sub-Saharan Africa still bears the brunt of the global HIV burden, the percentage of new infections in areas experiencing rapid growth in intravenous drug use and inadequate barrier protection (such as in parts of eastern Europe and central Asia, and in Pacific island territories including Fiji) has begun to increase.
Causes of HIV transmission
The air does not spread HIV and is not able to survive long outside the human body. HIV is spread through direct contact of certain body fluids that contain high levels of the virus into the blood or mucous membranes of an uninfected person.
“The Centers for Disease Control and Prevention (CDC) says that people can be infected with the virus in three main ways,” Anne Kamwila, Healthcare Policy Analyst, tells Blavity Health. “Unprotected sexual contact is the most frequent transmission mode worldwide, by engaging in condom-less receptive or insertive anal, vaginal or oral intercourse with the mucosal surfaces exposed to infectious blood, semen, pre-seminal fluid or vaginal secretions.”
She also points out that “Direct contact is from person to person through shared injecting equipment such as needles, syringes, cookers and other drug injection paraphernalia, especially among people who inject drugs. Needle-stick injuries or transfusion of unscreened blood products are also a direct route of transmission in healthcare settings with poor safety standards.”
Additionally, “Perinatal/vertical transmission is when the virus is spread from an untreated pregnant woman to her child before birth across the placenta, during labor through exposure to maternal blood and body fluids, or after birth to the baby through breast milk.”
You will not contract the virus from everyday activities like hugging, shaking hands, kissing with a closed mouth or sharing food utensils with an infected person, or from being bitten by mosquitoes or ticks.
Health risks and complications
If not clinically managed, an untreated HIV infection results in a gradual deterioration of the immune system, wasting and finally death due to opportunistic infections.
Clinical reviews at Mayo Clinic state that the major health issues are:
As the CD4 count drops below normal, severe opportunistic infections can occur. The most deadly global coinfection is tuberculosis (TB), which quickly advances in people living with HIV and is the #1 cause of death for people living with HIV worldwide. Other life-threatening opportunistic infections include: Pneumocystis jirovecii pneumonia (PCP), toxoplasmosis of the brain, cryptococcal meningitis, and the development of CMV retinitis with blindness.
Oncogenic viruses are associated with cancers, and cancers flourish in immunocompromised conditions. If HIV is not well controlled, patients with advanced disease are at significantly higher risk for the development of Kaposi sarcoma (caused by human herpesvirus 8), non-Hodgkin lymphomas (including primary central nervous system lymphoma), and invasive cervical cancer (caused by human papillomavirus, or HPV), NIH explains.
In the mild stages of chronic systemic inflammation, it is present. It contributes to accelerating atherosclerosis and long-term risks for cardiovascular disease, chronic kidney disease, metabolic liver dysfunction, and HIV associated neurocognitive disorders (HAND).
What to do about potential exposure and diagnosis
When dealing with possible exposure or a new diagnosis, there must be quick access to expert medical care and preventive pharmacology.
Post-Exposure Prophylaxis (PEP) is an urgent and important emergency intervention for people who have recently been exposed to HIV, such as due to a broken condom, sexual assault, or needle-stick injury, within the last 72 hours. PEP is a 28-day regimen of ARVs that, if started within 72 hours (preferably within 24 hours) of exposure, will prevent the virus from multiplying and becoming a permanent infection in the body.
Pre-Exposure Prophylaxis (PrEP) is extremely effective for those who remain at risk of exposure. Taken as a daily oral pill (such as emtricitabine/tenofovir) or administered as a long-acting bimonthly or biannual injection (such as cabotegravir or lenacapavir), PrEP reduces the risk of acquiring HIV from sexual contact by roughly 99% and from injection drug use by at least 74%.
Immediate treatment with Antiretroviral Therapy (ART) when diagnosed with HIV is the best medical practice today. Today’s ART consists of two or three drugs from different drug classes in one pill. These regimens inhibit viral enzymes such as reverse transcriptase, integrase and protease, thereby reducing viral activity to undetectable levels in the blood.
Decades of large-scale clinical trials (including the PARTNER and Opposites Attract studies) have proven the medical principle of U=U: an individual living with HIV who takes antiretroviral therapy as prescribed and maintains an undetectable viral load in their blood cannot sexually transmit the virus to HIV-negative partners.
When to see a doctor
If you have had condomless sex with a new or casual partner, shared needles, drug paraphernalia or had treatment for another sexually transmitted infection, or thought you might have been exposed to HIV in your job, you should ask your health care provider to evaluate you and ask for an HIV test.
About two-thirds of all people who are infected with HIV develop an acute retroviral syndrome two to four weeks after infection, according to the Mayo Clinic. If you suddenly develop flu-like symptoms, you should see a doctor right away if you have:
- A spiking fever accompanied by persistent night sweats and severe fatigue.
- A flat, non-itchy red rash distributed across the face, neck, trunk and arms.
- Painful, swollen lymph nodes in the neck, armpits, or groin that linger for weeks.
- Severe sore throat, painful mouth ulcers, muscle aches, joint pain and frequent diarrhea.
HIV is diagnosed with a rapid point-of-care antibody/antigen blood test or a fourth-generation laboratory immunoassay blood test, which identifies both HIV antibodies and the viral p24 antigen, and with quantitative viral load PCR testing to inform immediate treatment.
Will HIV ever be cured?
While much scientific progress has been made, one of the main challenges of modern biomedical research is to develop a universal and scalable cure for HIV.
The main challenge in curing the HIV infection is the latent viral reservoir. HIV can become latent when it enters resting memory CD4 T cells and integrates into the cell’s genome. These reservoirs are dormant, meaning the infected cells are not producing virus and are therefore not detectable by the immune system; antiretroviral drugs can only attack viruses that are actively replicating. When the patient discontinues a medication, latent cells awaken and active viral production resumes.
Nevertheless, researchers have accomplished clinical cures in a small number of patients, including the renowned “Berlin,” “London,” “Düsseldorf,” and “New York” patients. These individuals had blood cancers, in addition to HIV, and were allogeneically stem cell transplanted with donors that possessed a rare genetic mutation called CCR5-delta 32. This mutation did not have the coreceptor that HIV requires to infect human cells, making the transplanted donor cells resistant to HIV and, therefore, allowing them to clear the infection.
Scientists are working on ways to remove integrated viral DNA from host cells using genetic engineering tools like CRISPR-Cas9, therapeutic vaccines to teach the immune system to eliminate the remaining reservoirs, and “kick-and-kill” latency-reversing agents—none of which are yet ready to be applied to non-cancer patients because of the high mortality risk associated with stem cell transplants.
“There is an increased awareness of HIV status and use of PrEP, but it isn’t across the board,” said Dr. Marc Siegel, MD, professor of medicine at NYU Langone Medical Center. “Racial disparities persist, with a much higher incidence among the Black and Latino population, as does poverty and distrust of the medical establishment in minority communities.”
Bottom line
The national HIV emergency in Fiji also highlights that the global HIV incidence rate has been significantly reduced. Still, there can be sudden HIV epidemics within the region when fueled by intravenous substance use, low barrier protection and social stigma. If not treated, HIV gradually weakens the immune system, which can result in a serious deficiency of CD4 helper cells and a susceptibility to other infections, such as tuberculosis. By making HIV antibody testing widely available, harm reduction programs and consistent antiretroviral therapy, people with HIV can maintain an undetectable viral load and live long, healthy lives without the opportunity of onward sexual transmission.
Frequently Asked Questions
How long can a person with HIV live?
With early diagnosis and consistent adherence to modern antiretroviral therapy, a person living with HIV can expect to live a normal, full lifespan comparable to someone without the virus.
Which celebrities have HIV?
Notable public figures living openly with HIV who advocate for global testing and education include NBA legend Magic Johnson, Broadway star Billy Porter and Olympic diver Greg Louganis.
Citations
Harvey L. Fiji declares HIV emergency. One in 60 people now have the virus as drug crisis fuels outbreak. CNN. Published September 16, 2026. https://www.cnn.com/2026/09/16/asia/fiji-hiv-emergency-methamphetamine-intl-hnk
Magomere E, Olwal CO, Tetteh BE, et al. The Confluence of HIV‐1 and HIV‐2: Implications for Disease Progression and Insights for Therapy. International Journal of Microbiology. 2025;2025(1). doi:10.1155/ijm/3145677
World Health Organization. HIV/AIDS. World Health Organization. Published 2024. https://www.who.int/data/gho/data/themes/hiv-aids
Ng K. Fiji declares national emergency as HIV cases surge. BBC. https://www.bbc.com/news/articles/c3zxz7le4e92o
Palanee-Phillips T, Rees HV, Heller KB, et al. High HIV incidence among young women in South Africa: Data from a large prospective study. Kharsany AB, ed. PLOS ONE. 2022;17(6):e0269317. doi:10.1371/journal.pone.0269317
CDC. How HIV Spreads. HIV. Published November 25, 2024. https://www.cdc.gov/hiv/causes/index.html
Yarchoan R, Uldrick TS. HIV-Associated Cancers and Related Diseases. Longo DL, ed. New England Journal of Medicine. 2018;378(11):1029-1041. doi:10.1056/nejmra1615896
HIV.gov. Pre-Exposure Prophylaxis. HIV.gov. Published February 7, 2025. https://www.hiv.gov/hiv-basics/hiv-prevention/using-hiv-medication-to-reduce-risk/pre-exposure-prophylaxis
Mayo Clinic. HIV/AIDS – Symptoms and causes. Mayo Clinic. Published February 9, 2024. https://www.mayoclinic.org/diseases-conditions/hiv-aids/symptoms-causes/syc-20373524