Photo: Kuebi = Armin Kübelbeck, CC BY-SA 3.0
A new report on HIV in Fiji is recommending the set-up of a needle syringe program, to provide sterile needles, as soon as possible.
The report was commissioned by WHO and UNDP, and included information from interviews with 56 people who inject drugs and five talanoas with 50 key informants representing civil society, health care workers, government ministries, law enforcement agencies, and faith-based organisations.
Fiji declared an outbreak of HIV in January, and the UN Development Programme delivered 3000 antiretroviral drugs to Fiji to support the HIV response.
"Right now [crystal methamphetamine] is an easy thing. It's like buying sugar at a canteen near your place," said a 31-year-old transgender woman.
"And everybody is using it now from even underage children, teenager, businessmen, party lovers, night crawlers, sex workers, drivers.
"I do it in parties. And usually for sex... and yeah for fun, for stress relief."
Several people who took part in talanoa reported observing young children involved in the selling of drugs.
"Nine years old, eight years old, and some in secondary school. They'll be standing at the village food parks, selling marijuana and some even smoking them," someone said in a talanoa with religious leaders and faith-based organisations.
"They show off the marijuana first, but if you want something better than that, then they 'll just get it ... some they're selling ice."
A ministerial representative said it's not just people on the street who are using.
"I have doctors and nurses who are using drugs. Why? Because it stimulates them. It makes them focused. They can keep awake for
longer hours so they can do the shift more. So the same thing, like rugby players you know, so it's everywhere."
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Family members, including parents, cousins and uncles, were often involved in initiating young people, particularly young men, into injecting drugs. Participants reported a range of patterns of use, ranging from multiple daily injections (typically three-four injections) to regular weekend use or sporadic binges.
The majority of participants reported injecting at least daily at the time of interview.
Interview participants had "extremely limited" knowledge about HIV transmission and injecting drug use, the report said.
One 33-year-old woman, who was a sex worker, believed it was a progression from syphilis.
"First they'll have syphilis and this kind of disease, go step by step," she said.
"Okay, so you're not really aware of what HIV means?" The interviewer said.
"Not really. So what are you saying? You said that we can get it directly?"
While most, but not all, interview participants were aware that HIV could be transmitted parenterally in the context of unsafe injections, few understood the specific risks involved beyond sharing needles or which injecting practices could expose them to the virus.
Needles laying on the street. Photo: Facebook / Seta Kalesita
The report said the assessment shows the HIV epidemic among people who inject drugs is the result of multiple factors.
These include syringe scarcity and stigmatisation, unsafe injecting and drug preparation practices, combined with little or no blood awareness; limited knowledge of HIV or other blood-borne infections, and limited or no access to services, including needle syringe programs (NSP) and HIV testing and treatment.
The report recommends accessible needle and syringe distribution via a range of outlets, including peers, pharmacies and health services.
Interview participants say sterile needles and syringes are a scarce commodity in Suva. Without exception, participants reported difficulties accessing
sterile needles and syringes for injection.
"These services should be low threshold e.g. free needles and syringes should be provided without the need for registration, counselling, HIV testing or the exchange of used needles and syringes," the report said.
It also said it would be important that sterile needle programmes are linked to health services, including HIV prevention and testing and treatment services, and that they act as a referral pathway to evidence-based drug treatment and mental health support, as necessary.
"Expanding access to sterile injecting equipment is the most urgent and effective measure to prevent HIV and hepatitis C transmission among people who inject drugs," the report said.
"Delays in implementation will result in continued preventable infections.
"Low-threshold services reduce barriers and stigma. Avoiding registration, eligibility screening, and exchange requirements encourages access and also fosters trust in services."
It also recommended increasing the number of people who inject drugs living with HIV who receive testing and treatment.
"Diagnosis of HIV followed by timely ART [antiretroviral therapy] initiation and support for adherence are essential for individual and public health."
The report also said bluetoothing appeared to be less common than perceived, with only two participants reporting direct experience of it.
