HIV/AIDS in the Pacific: The emerging threats of crystal meth and needle reuse
Majuro—Our Pacific island nations, known for their idyllic landscapes and rich cultural heritage, continue to face increasing challenges from serious public health threats, which I addressed in some of my earlier articles.
One of the most pressing issues in our region is the rise of crystal methamphetamine use, commonly known worldwide as “ice.” In the Marshall Islands, the locals call it “rice” because it resembles grains.
While the Pacific’s isolated geography has provided some defense against the global pandemic as we witnessed recently with our very successful regional response to Covid-19, today’s interconnected world continues to present us with new health and public safety threats. HIV/AIDS, compounded by the meth epidemic, poses a formidable challenge to our regional public health systems already grappling with limited resources.
Historically, our Pacific island nations have had relatively low reported numbers of HIV/AIDS cases compared to other regions. According to UNAIDS, the prevalence of HIV in the Pacific islands has remained low, but that data masks the real potential for an outbreak given some of our recent socio-economic trends. Between 2020 and 2023, reports showed a steady increase in the number of people diagnosed with HIV in some of our countries like Papua New Guinea and Fiji.
Papua New Guinea, with a population of approximately 9 million, bears the brunt of the Pacific’s HIV epidemic, accounting for around 90 percent of all reported HIV cases in the region. As of 2021, UNAIDS estimated that about 50,000 people were living with HIV in Papua New Guinea alone. A complex mix of cultural, economic and geographical factors contributes to the spread of the virus across our island nations, and despite efforts, prevention and treatment services remain inconsistent at best.
From January to June this year, 553 new cases of HIV were recorded in Fiji. Many of these were injecting drug users or their partners. This is compared to 100 new cases for the entire year of 2014.
In smaller nations, such as Tonga and Samoa, the number of HIV/AIDS cases has remained low, but health authorities are cautious as the virus has shown it can spread quickly in vulnerable populations.
In recent years, our small island nations have seen a rapid rise in meth abuse driven by aggressive drug trafficking networks, poverty and unemployment. These socio-economic pressures, combined with increasing urbanization and migration into our central island districts, have made the Pacific islands particularly vulnerable to the drug trade.
This scourge has impacted our young people. During my time as secretary of health, it was not unusual to see young people, even teenagers, being rushed to our hospital with heart attacks or strokes related to crystal meth abuse.
According to a 2021 report by the Pacific Islands Forum Secretariat, the trafficking and use of meth have surged in Fiji, Tonga, Samoa and Palau. These countries have become not only transit points for drugs headed to larger markets like Australia and New Zealand but also direct consumers of methamphetamine. Fiji’s police commissioner noted in a 2022 report that methamphetamine-related arrests had quadrupled in the previous five years.
This alarming rise in methamphetamine consumption has brought with it a host of related social and health problems, including violent crimes, family disintegration--now a noticeable, growing problem in the Marshall Islands– and most critically, an increase in intravenous drug use.
The rise in meth use directly impacts the transmission of HIV in the Pacific island countries. Intravenous drug users are at high risk of contracting HIV due to needle-sharing, a behavior strongly associated with meth use.
In Fiji, the reuse and sharing of needles are common practices among drug users. According to the Pacific Harm Reduction Network's 2022 study, over 60 percent of drug users surveyed in Fiji admitted to sharing needles.
Research conducted by the World Health Organization and the Joint United Nations Program on HIV/AIDS indicates that the spread of HIV among intravenous drug users is significantly higher in regions with inadequate harm reduction programs, such as needle exchange initiatives and drug rehabilitation services. There are no needle and syringe programs in the Pacific region. Though it may seem counterintuitive to make drug paraphernalia available for drug users, needle and syringe programs have proven to be one of the most effective and economical ways to address HIV/AIDS transmission.
Meth causes hypersexual behavior, including unprotected sex, which increases the likelihood of HIV transmission. The Pacific Sexual Health and Wellbeing Survey in 2021 found that 40 percent of meth users in Papua New Guinea reported engaging in unprotected sex during drug use, heightening their risk of contracting sexually transmitted infections.
The inadequacy of public health infrastructures and a lack of comprehensive harm reduction services exacerbate the problem. In many island countries, access to proper healthcare services is limited, particularly in remote areas. This situation makes it difficult for health professionals to contain the HIV epidemic among vulnerable populations, including drug users.
Another key challenge in combating both HIV/AIDS and meth use in the Pacific islands is the stigma surrounding these issues. Our region has strong religious and cultural values that contribute to the stigmatization of drug users and people living with HIV. Many communities view HIV/AIDS as a “moral disease,” and individuals who are infected face social isolation.
This stigma often prevents people from seeking the help they need. The 2022 Pacific Islands HIV Prevention and Care Report highlighted that fear of discrimination and social ostracization leads to delayed diagnosis and treatment for many HIV-positive individuals, particularly those who use intravenous drugs. In some cases, healthcare providers themselves hold stigmatizing attitudes toward drug users and people living with HIV, further discouraging individuals from accessing medical services.
Another significant concern is the lack of targeted education and prevention campaigns. While HIV/AIDS awareness programs exist in some of our countries, they often fail to reach key populations, including drug users and marginalized communities. In Fiji, for example, a 2020 survey conducted by the Ministry of Health found that only 25 percent of drug users were aware of the risks of HIV transmission through needle sharing.
To effectively address the dual threats of HIV/AIDS and meth use in our islands, we need a multifaceted approach including the implementation of harm-reduction programs such as needle exchange initiatives. A 2023 report by the Global Fund to Fight AIDS, tuberculosis and malaria highlighted the success of needle-exchange programs in reducing HIV transmission among drug users in other regions, and similar initiatives could be adopted for the Pacific islands.
We are facing a growing public health crisis with meth use and HIV/AIDS converging into a dual epidemic.
Addressing this crisis will require strategic planning that includes governments, international organizations, and local communities. By focusing on harm reduction, increasing access to healthcare, and reducing stigma, our island nations can better protect our populations from the devastating consequences of HIV/AIDS and methamphetamine use.
Jack Niedenthal is the former secretary of health services for the Marshall Islands, where he has lived and worked for 43 years. He is the author of “For the Good of Mankind, An Oral History of the People of Bikini,” and president of Microwave Films, which has produced six award-winning feature films in the Marshallese language. Send feedback to jackniedenthal@gmail.com
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