The Pacific and HIV: A chance to turn the tide — Eamonn Murphy, Saia Ma’u Piukala, Pio Smith, Beate Trankmann and Delphine Schantz

OCT 27 — The world has spent more than 40 years learning what works in the AIDS response. For the Pacific, with its long tradition of collective action in tackling shared challenges, those hard-won lessons could help prevent today’s growing HIV epidemics from becoming a much larger crisis.

The recent surge of international attention to Fiji’s HIV epidemic has carried uncomfortable echoes of an earlier era of AIDS.

A rapid rise in new infections. A national crisis declaration. Stories of people struggling to access services or staying away because of pervasive stigma. Health systems racing to catch up with an epidemic moving faster than the response. Once again, HIV has made international headlines with an urgency many had hoped belonged to the past.

But there is one fundamental difference. This is 2026.

Today, we have effective treatment, powerful new prevention tools and decades of experience that did not exist at the start of the AIDS epidemic. The Pacific cannot afford to lose time or repeat past mistakes.

The need to act is urgent: Fiji has seen one of the fastest-growing HIV epidemics globally, with new infections rising approximately twelvefold between 2010 and 2025. But Fiji is not the only warning sign. Papua New Guinea remains the largest HIV epidemic in the region, with an estimated 110,000 people living with HIV. HIV diagnoses have also risen recently in Palau, Solomon Islands and Vanuatu. Across the Pacific, new infections increased by an estimated 65 per cent between 2010 and 2025, while they declined across Asia and the Pacific overall.

In countries with small populations, even relatively few new infections can signal a major shift in the epidemic. Waiting until the numbers become alarming means losing valuable time to prevent further transmission.

First, HIV is everyone’s concern

In 1989, American artist and activist Keith Haring painted a mural: Todos juntos podemos parar el sida—Together We Can Stop AIDS. More than a slogan, it captured the spirit of a movement that brought together people who had rarely worked side by side: doctors and politicians, activists and scientists, faith leaders and teachers, police and community advocates, celebrities and people living with HIV.

That mobilisation required heads of state to speak publicly about AIDS, parliaments to change laws that fuelled stigma or blocked access to services, and societies to confront deep-seated prejudice. The early AIDS response showed how fear and misinformation can contribute to discrimination—a lesson worth bearing in mind when measures such as mandatory testing or restrictive border controls are considered. It also demanded action across sectors: from health and education to law enforcement and justice, alongside broader efforts to advance human rights, gender equality and development.

Fiji’s declaration of a national HIV crisis is an important political step. It recognises that the health sector cannot tackle the epidemic alone.

Across the Pacific, addressing discriminatory laws, stigma and other barriers to prevention and treatment requires the kind of political leadership and collective action that shaped the global AIDS response.

Second, let communities lead

The AIDS response was transformed by the communities most affected by HIV. They challenged stigma, fought for access to treatment and helped shape services around people’s needs.

Even today, despite advances in treatment and prevention, stigma and discrimination still keep many people away from HIV services. Fear of judgement or unwanted disclosure can determine whether someone seeks testing or treatment at all.

Community organisations and peer outreach workers help bridge that gap by building trust and reaching people who might otherwise remain outside the health system. This is especially important in the Pacific, where small island communities and remote settings can make privacy harder to protect and confidentiality all the more important.

As Pacific countries move towards greater national ownership and sustainable financing, community-led services need to become an integral part of national HIV plans and budgets, rather than remain dependent on short-term donor-funded projects. With external funding under pressure, this transition must not come at the cost of prevention, or of the independence and trust that make these services effective.

Third, close the gap between progress and access

Medical science has transformed what is possible. Antiretroviral treatment now enables people living with HIV to lead long, healthy lives.

When people take effective antiretroviral treatment and achieve and maintain an undetectable viral load, they do not transmit HIV sexually—the principle known as U=U, or Undetectable = Untransmittable.

Yet treatment coverage remains alarmingly low in parts of the Pacific. In Fiji, only about a quarter of the total estimated people living with HIV accessed treatment, and in Papua New Guinea, only about half.

Effective treatment during pregnancy and breastfeeding can protect women’s health and prevent HIV transmission to their babies. In Papua New Guinea, however, only about one in four pregnant women living with HIV receive antiretroviral treatment, and an estimated 2,700 infants acquired HIV in 2024—a stark reminder of the distance that can remain between what medicine makes possible and what reaches families in time. That is why HIV testing and treatment need to be readily accessible through routine antenatal, maternal and child health services, including in remote communities.

Prevention has entered a new era too. In countries where injecting drug use is one of the risks driving increasing HIV cases, needle and syringe programmes play a critical role in preventing needle sharing—something that poses very high risks for HIV spread. These programmes don’t just protect people who inject drugs; they also protect their loved ones, and the broader community.

Alongside proven approaches such as condoms, harm reduction and oral pre-exposure prophylaxis (PrEP), twice-yearly injectable lenacapavir offers an important new option, particularly for people who find taking a daily pill difficult.

Prevention is increasingly about choice: matching proven options to people’s needs and lives. In Fiji, where HIV infections linked to injecting drug use are increasing, recent legal changes have made it possible to introduce a needle and syringe programme—showing how prevention can adapt as the epidemic changes.

But none of these advances can prevent infections or save lives if people cannot access them. New prevention and treatment options need to reach Pacific countries sooner, at prices they can afford.

Access is about more than medicines. Many Pacific nations already face shortages of health workers, limited resources and the high costs of delivering care across remote islands. Climate change adds to these pressures, as extreme weather threatens health facilities and disrupts essential services.

As countries expand their HIV responses, prevention, testing and treatment can be integrated into primary health care and other essential services rather than built as costly parallel systems. This can make care easier to access, use scarce resources more effectively and strengthen health systems for the future, while preserving the specialised and community-led services that people trust.

Services also need to reach people who are often missed, including people in prisons, and ensure continuity of prevention, treatment and care when they return to the community.

For smaller Pacific countries, greater national ownership cannot mean going it alone. Sustained international financing will still be needed alongside growing domestic investment. Regional cooperation can help those resources go further—through pooled procurement, stronger supply chains and shared expertise. Not every country needs to build every service or specialist capability from scratch.

Pacific institutions such as the Pacific Community (SPC), working alongside the UN Joint Programme on HIV/AIDS (UNAIDS)—including UNDP, UNFPA, UNODC and WHO—can help countries put these shared solutions into practice, bringing governments, communities and development partners together around national priorities.

An opportunity the Pacific cannot afford to miss

Only four years remain until 2030, the target year set by UN Member States for ending AIDS as a public health threat. The UN Political Declaration on HIV/AIDS, adopted in June 2026, renewed commitments to prevention and treatment, human rights, community leadership and sustainable financing.

The Pacific has the knowledge, the tools and a strong history of collective action. What happens next will shape the region’s HIV epidemics for years to come.

Fiji’s experience is a warning for the entire region. But it can also become a turning point.

*Eamonn Murphy is UNAIDS Regional Director for Asia and the Pacific and Eastern Europe and Central Asia; Dr Saia Ma’u Piukala is WHO Regional Director for the Western Pacific; Pio Smith is UNFPA Regional Director for Asia and the Pacific; Beate Trankmann is UNDP Deputy Regional Director for Asia and the Pacific and Director of the Bangkok Regional Hub; and Delphine Schantz is UNODC Regional Representative for Southeast Asia and the Pacific.

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10月27日——世界在艾滋病防治领域已经摸索了40多年，总结出了行之有效的经验。对于拥有长期集体应对共同挑战传统的太平洋地区而言，这些来之不易的经验教训或许能够帮助防止当前日益严重的艾滋病疫情演变成更大的危机。

最近国际社会对斐济艾滋病疫情的关注度激增，这让人不禁回想起早年艾滋病肆虐的时期，感到十分不安。

新增感染病例激增。国家宣布进入危机状态。人们难以获得医疗服务，或因根深蒂固的歧视而选择远离医疗机构。医疗系统疲于应对疫情蔓延的速度远超应对能力。艾滋病再次成为国际关注的焦点，其紧迫性之高，曾让许多人希望成为历史。

但有一个根本性的区别。现在是2026年。

如今，我们拥有有效的治疗方法、强有力的新型预防工具以及数十年的经验，这些都是艾滋病疫情爆发初期所不具备的。太平洋地区不能再浪费时间，也不能重蹈覆辙。

采取行动刻不容缓：斐济是全球艾滋病疫情增长速度最快的国家之一，2010年至2025年间新增感染人数增长了约12倍。但斐济并非唯一的警示信号。巴布亚新几内亚仍然是该地区艾滋病疫情最严重的国家，估计有11万人感染艾滋病毒。帕劳、所罗门群岛和瓦努阿图的艾滋病毒感染病例近期也有所上升。整个太平洋地区的新增感染人数预计在2010年至2025年间增长了65%，而亚洲和太平洋地区的整体新增感染人数则呈下降趋势。

在人口较少的国家，即使新增感染病例相对较少，也可能预示着疫情的重大转变。等到感染人数达到令人担忧的程度才采取行动，意味着错失阻止疫情进一步传播的宝贵时间。

首先，艾滋病是每个人的事。

1989年，美国艺术家兼活动家基思·哈林创作了一幅壁画：《Todos juntos podemos parar el sida》（携手共克时艰——我们携手就能战胜艾滋病）。这不仅仅是一句口号，它捕捉到了这场运动的精神，这场运动将原本鲜少并肩工作的人们团结起来：医生和政治家、活动家和科学家、宗教领袖和教师、警察和社区倡导者、名人以及艾滋病毒感染者。

这场动员要求各国元首公开谈论艾滋病，要求议会修改那些加剧歧视或阻碍人们获得服务的法律，要求社会正视根深蒂固的偏见。早期的艾滋病应对措施表明，恐惧和错误信息会如何助长歧视——在考虑强制检测或严格的边境管制等措施时，这一教训值得我们铭记。它还要求各部门采取行动：从卫生和教育到执法和司法，以及在更广泛的范围内推进人权、性别平等和发展。

斐济宣布全国进入艾滋病危机状态，这是一个重要的政治举措。它表明，仅靠卫生部门无法应对这一流行病。

在太平洋地区，要解决歧视性法律、污名化以及其他预防和治疗障碍，需要像塑造全球艾滋病应对措施那样的政治领导和集体行动。

第二，让社区主导

艾滋病防治工作因受艾滋病毒影响最严重的社区而发生转变。他们挑战歧视，争取获得治疗的机会，并帮助根据人们的需求调整服务。

即使在今天，尽管治疗和预防方面取得了进展，但污名化和歧视仍然阻碍着许多人获得艾滋病防治服务。害怕被评判或被泄露隐私可能会决定一个人是否寻求检测或治疗。

社区组织和同伴外展工作者通过建立信任并接触那些可能被排除在医疗体系之外的人群，帮助弥合这一差距。这在太平洋地区尤为重要，因为那里的小岛屿社区和偏远环境使得隐私更难保护，保密性也因此显得更加重要。

随着太平洋岛国逐步实现更大的国家自主权和可持续融资，社区主导的服务需要成为国家艾滋病防治计划和预算的组成部分，而不是继续依赖短期捐助方资助的项目。在外部资金面临压力的情况下，这种转变绝不能以牺牲预防工作或保障这些服务有效性的独立性和信任度为代价。

第三，缩小进展与获取途径之间的差距

医学科学彻底改变了人们的生活。抗逆转录病毒治疗如今使艾滋病病毒感染者能够过上健康长寿的生活。

当人们接受有效的抗逆转录病毒治疗并达到并保持病毒载量检测不到的水平时，他们就不会通过性行为传播 HIV——这一原则被称为 U=U，即检测不到 = 无法传播。

然而，太平洋部分地区的治疗覆盖率仍然低得惊人。在斐济，估计只有约四分之一的艾滋病毒感染者接受了治疗；在巴布亚新几内亚，这一比例仅为一半左右。

在孕期和哺乳期进行有效治疗可以保护妇女健康，并预防艾滋病毒传播给婴儿。然而，在巴布亚新几内亚，只有大约四分之一感染艾滋病毒的孕妇接受抗逆转录病毒治疗，预计到2024年将有2700名婴儿感染艾滋病毒——这鲜明地提醒我们，医学的进步与及时惠及家庭之间仍然存在着巨大的差距。因此，必须通过常规的产前、孕产妇和儿童保健服务，包括偏远社区，确保人们能够便捷地获得艾滋病毒检测和治疗。

预防工作也进入了一个新时代。在一些国家，注射吸毒是导致艾滋病毒感染病例增加的风险因素之一，针具交换项目在预防共用针头方面发挥着至关重要的作用——共用针头会造成极高的艾滋病毒传播风险。这些项目不仅保护注射吸毒者，也保护他们的亲人和更广泛的社区。

除了避孕套、减少危害和口服暴露前预防 (PrEP) 等行之有效的方法外，每年两次注射的来那卡帕韦提供了一种重要的新选择，尤其适合那些觉得每天服药很困难的人。

预防工作越来越注重选择：将行之有效的方案与人们的需求和生活方式相匹配。在斐济，与注射吸毒相关的艾滋病毒感染病例不断增加，近期法律的修改使得针具交换计划得以实施——这表明预防措施可以随着疫情的变化而调整。

但如果人们无法获得这些技术，它们就无法预防感染或挽救生命。新的预防和治疗方案需要尽快以人们能够负担得起的价格惠及太平洋岛国。

医疗服务可及性不仅仅关乎药品。许多太平洋岛国本就面临医护人员短缺、资源匮乏以及在偏远岛屿提供医疗服务成本高昂等问题。气候变化加剧了这些压力，极端天气威胁着医疗设施并扰乱了基本服务。

随着各国扩大艾滋病应对措施，预防、检测和治疗可以融入初级卫生保健和其他基本服务体系，而不是建立成本高昂的独立系统。这既能使人们更容易获得医疗服务，更有效地利用稀缺资源，又能加强未来的卫生系统建设，同时还能保留人们信赖的专业化和社区主导型服务。

服务还需要惠及那些经常被忽视的人群，包括监狱中的人员，并确保他们在重返社区后能够继续获得预防、治疗和护理服务。

对于较小的太平洋岛国而言，增强国家自主权并不意味着单打独斗。在不断增长的国内投资之外，持续的国际融资仍然必不可少。区域合作可以通过联合采购、强化供应链和共享专业知识，帮助这些资源发挥更大的作用。并非每个国家都需要从零开始构建每一项服务或专业能力。

太平洋共同体（SPC）等太平洋机构与联合国艾滋病规划署（UNAIDS）（包括联合国开发计划署、联合国人口基金、联合国毒品和犯罪问题办公室和世界卫生组织）合作，可以帮助各国将这些共同的解决方案付诸实践，将政府、社区和发展伙伴聚集在一起，围绕国家优先事项开展工作。

这是太平洋地区不容错过的机会。

距离联合国成员国设定的消除艾滋病作为公共卫生威胁的目标年份——2030年——仅剩四年时间。2026年6月通过的《联合国艾滋病毒/艾滋病政治宣言》重申了对预防和治疗、人权、社区领导和可持续融资的承诺。

太平洋地区拥有相关的知识、工具和强大的集体行动历史。接下来的发展将影响该地区未来数年的艾滋病疫情形势。

斐济的经历对整个地区来说是一个警示，但也可能成为一个转折点。

*Eamonn Murphy 是联合国艾滋病规划署亚太及东欧和中亚区域主任；Saia Ma'u Piukala 博士是世界卫生组织西太平洋区域主任；Pio Smith 是联合国人口基金亚太区域主任；Beate Trankmann 是联合国开发计划署亚太区域副主任兼曼谷区域中心主任；Delphine Schantz 是联合国毒品和犯罪问题办公室东南亚及太平洋区域代表。

南希·舒克里警告说，扣留基本生活必需品可能构成家庭虐待，并敦促受害者寻求帮助。

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