HIV treatment bill could hit $150m, warns response chair

Fiji’s escalating HIV outbreak is no longer only a public health crisis — it is fast becoming a fiscal threat, with projected treatment costs far exceeding the national pharmaceutical budget.

Dr Jason Mitchell, chairperson of the National HIV Outbreak Response, warned that if all 7000 people living with HIV were placed on treatment, alongside care for related opportunistic infections, the annual cost could reach an estimated $150 million. Fiji’s current pharmaceutical budget is less than $40 million.

“The numbers simply don’t add up,” Dr Mitchell said.

He said the sharp rise in infections over the past five years had largely been attributed to injection drug use and the sharing of needles and syringes, which now account for 48 per cent of new infections. Group injection practices have accelerated transmission rates, creating clusters of infections that multiply healthcare liabilities almost overnight.

"Unlike short-term outbreaks, HIV requires lifelong treatment. Once patients begin antiretroviral therapy, the cost becomes a permanent annual commitment," he said.

"As cases increase, so too does the government’s long-term fiscal exposure."

Dr Mitchell said the strain was already visible across the health system, with hospitals managing growing numbers of severely ill HIV patients, many presenting late without treatment.

"Tuberculosis wards report high levels of HIV co-infection, while limited ICU beds are being occupied for extended periods by preventable complications diverting resources from other critical care," Dr Mitchell said.

"Beyond healthcare, the outbreak poses macroeconomic risks. Tourism contributes roughly 40% of Fiji’s GDP, and officials have expressed concern that international coverage of the HIV and drug crisis may affect visitor confidence. At the same time, untreated HIV among working-age adults threatens productivity across key sectors including tourism, manufacturing and public services."

Dr Mitchell argued that prevention was fiscally smarter than long-term treatment. Needle and Syringe Programs, expanded condom use and access to preventive medications cost significantly less than decades of medical care.