斐济人口约93万人，其中估计有9100人目前感染了HIV。 斐济每60名成年人中就有1人感染HIV，但最近的紧急声明可能会帮助解决诸如针头共享等关键问题。在最近的一个星期五晚上，医疗服务太平洋组织的Kesaia Tuidraki博士带领的医疗团队在斐济苏瓦市中心麦当劳外停下他们的移动诊所，抓住他们能找到的任何孩子进行HIV检测。97人接受筛查，其中大多数是青少年——有的正在去吃汉堡的路上，有的去买毒品——1/6的人检测呈阳性。
Fiji has a population of about 930,000 people, with an estimated 9,100 now living with HIV. One in 60 adults Fiji lives with HIV but a recent emergency declaration may help address key issues such as syringe sharing n a recent Friday night, Dr Kesaia Tuidraki’s medical team parked its mobile clinic outside McDonald’s in downtown Suva, Fiji and grabbed any kid they could to be tested for HIV. Of the 97 people screened, mostly teenagers – some on their way to get a burger, others to buy drugs – one in six tested positive.
“孩子们正在受苦，孩子们正在死去，如果这不能动你们的心，那我不知道什么能动了”，Tuidraki博士，医疗服务太平洋组织的国家主任，对《卫报》说道。
“Children are suffering, children are dying, and if that doesn’t move you I don’t know what will,” Tuidraki, country director of Medical Services Pacific, tells the Guardian.
斐济当局本月宣布国家卫生紧急状态，以应对激增的HIV病例，估计目前有1/60的成年人感染了这种病毒。这与新的感染病例激增有关，2025年诊断出2016例新病例，同比增长27%，并代表自2010年以来增长了12倍，据联合国艾滋机构报道。在一个人口约93万人的紧密联系岛国家中，估计有9100人目前感染了这种病毒。
Fijian authorities this month called a national health emergency to deal with surging HIV cases with an estimated one in 60 adults now living with the virus. It comes as new infections surge, with 2,016 new cases diagnosed in 2025 – rising by 27% in a year, and representing a 12-fold increase since 2010, according to UNAids. In a close-knit island nation of about 930,000 people, an estimated 9,100 are now living with the virus.
但只有一小部分人接受检测并获得治疗，这促使政府扩大其大流行公告——最初在2025年2月做出——并动员紧急措施防止其传播。斐济HIV流行应对负责人Jason Mitchell博士说，可能需要5到10年的时间来控制这种病毒，在此期间他预计数字会继续上升。
But only a fraction of those are tested and access treatment, prompting the government to scale up its pandemic announcement – first made in February 2025 – and mobilise urgent measures to prevent its spread. Dr Jason Mitchell, the head of Fiji’s HIV epidemic response, said it could take between five and 10 years to get a handle on the virus, and in the meantime he would expect numbers to rise.
批评人士表示，应对由年轻人群感染驱动的疾病传播的举措过于缓慢，尤其是15至34岁年龄段的新诊断病例最多。危机复杂且与毒品危机密不可分——2025年新增病例的42%以上是由于共享被污染的针头或设备所致。在斐济运行HIV检测诊所的医护人员。
Critics say moves to stem the spread of a disease that is being driven by cases in the young, with new diagnoses highest in those aged between 15 and 34, has been too slow. The crisis is complex and inextricably linked to the drug epidemic – more than 42% of new cases in 2025 were due to sharing contaminated needles or equipment.
照片：由医疗服务机构提供。太平洋地区的健康倡导者及社会工作者称，一些小学年龄段的儿童也在自行注射毒品，他们还会与同伴共用同一支受污染的针头。早在2019年，倡导者们便已提出这一问题。
Healthcare workers running an HIV testing clinics in Fiji. Photograph: supplied by Medical Services Pacific Health advocates and social workers say primary school-age children are among those injecting themselves and friends are using the same contaminated needle, a problem raised by advocates as far back as 2019.
“我认识这些小男孩，他们会向我索要注射器，”感染艾滋病毒的注射吸毒者罗谢尔*对《卫报》说道。“只要我有多余的注射器，就会分给他们。总得有人提供吧，反正他们已经在使用毒品了。”现年38岁的罗谢尔表示，她会尽量劝告这些男孩不要共用针头，不过孩子们有时会听劝，有时则不然。根据现行法律，分发注射器在技术上属于协助他人吸毒行为。
“I know these young boys, they ask me for syringes,” injecting drug user Rochelle*, who is living with HIV, tells the Guardian. “Whenever I have them I give them out. Someone has to give them, they’re already accessing the drugs.”Rochelle, 38, says she tries to tell the boys not to share. Sometimes the kids listen – but not always. Under current law, giving out syringes is technically considered aiding and abetting drug use.
部分政界人士与医疗从业者担心，提供针头会助长吸毒行为——尽管联合国艾滋病规划署的证据表明事实并非如此。因此，健康倡导者们正敦促政府允许他们分发目前存放在苏瓦一处仓库中、尚未动用的数千支针头与注射器。
A concern among some politicians and medical professionals is that providing needles would encourage drug use – despite evidence from UNAids that this is not the case –and advocates are urging the government to let them distribute thousands of needles and syringes sitting untouched in a Suva warehouse.
“真的很令人痛心。我们实在等不下去了，仓库里已经堆满了成箱的物资，”图伊德拉基说道。
“It’s really sad, honestly. We can’t wait any more, there are boxes and boxes already here,” Tuidraki says.
米切尔称，他预计未来两周内将通过《艾滋病毒法》修正案，允许公共卫生工作者分发针头。他还表示，政府在宣布这一紧急措施时一直持“谨慎”态度，而他的部门自6月起便一直在呼吁采取相关举措。
Mitchell says he expects a change to the HIV Act to be passed within the next two weeks, allowing public health workers to distribute needles. He adds that the government has been “cautious” in announcing the emergency, which his unit had been asking for since June.
负责应对工作的相关人员指出，此次紧急状态所赋予的更多权限将有助于遏制艾滋病毒的快速传播，尤其是防止其扩散至母亲与婴儿等易感人群。预计每年为此需额外支出2300万斐济元（约合1020万美元）。
Those leading the response say increased powers arising from the emergency declaration will help to quell the rapid spread of HIV, including to vulnerable populations like mothers and babies, at an estimated extra cost of $23m FJD (US$10.2m) a year.
“当前最紧迫的危机就是艾滋病毒的传播，正因如此，针头与注射器发放计划至关重要，”联合国抗击艾滋病毒与艾滋病的专门机构——联合国艾滋病规划署的区域主任伊蒙·墨菲说道。“人们现在都很恐慌。”
“The immediate crisis right now is the spread of HIV, which is why the needle and syringe programme is critical,” UNAids, the UN agency that fights HIV and Aids, regional director Eamonn Murphy said. ‘People are scared’
这场疫情情况复杂，但与甲基苯丙胺滥用密切相关。斐济是太平洋地区向澳大利亚和新西兰市场输送甲基苯丙胺的重要中转站；疫情封锁期间，毒品使用情况进一步恶化，甲基苯丙胺也开始在本地流通。
The epidemic is complex but heavily linked to methamphetamine use. Fiji is a drug-running hub in the Pacific for methamphetamine bound for Australian and New Zealand markets, but use escalated during Covid when borders were closed and it began circulating domestically.
虽然斐济民众希望妥善应对这一危机，但也出现了一些反对声音。据联合国艾滋病规划署统计，斐济只有39%的艾滋病毒感染者知晓自己的感染状况；《卫报》采访的一些人仍选择否认现实或拒绝接受检测。苏瓦的人行道上散落着用过的注射器。
While Fijians want the crisis addressed, there has also been a backlash. Only 39% of those living with HIV in Fiji know their status, according to UNAids, and some of those spoken to by the Guardian continued to live in denial or refuse testing. A syringe lies discarded on a sidewalk in Suva.
“有人指责同性恋群体，指责女性不负责任，网络霸凌现象也屡见不鲜，少数群体正遭受网络攻击，”身患艾滋病的权益倡导者马克·沙希尔·拉尔说道，“如今这件事更像是一场丑闻，人们都感到恐慌。”联合国艾滋病规划署同样担忧病毒会在太平洋地区扩散，所罗门群岛和巴布亚新几内亚的病例数正呈上升趋势。去年11月，澳大利亚外交部长彭妮· Wong宣布拨款4800万澳元用于帮助太平洋各国防治艾滋病毒/艾滋病；新西兰则于7月承诺向斐济提供420万新西兰元的援助。
“There are people blaming the [queer] community, blaming women as irresponsible people, there’s a lot of cyberbullying. Minorities are being attacked online,” Mark Shaheel Lal, an advocate who lives with HIV, says. “Now it’s more like a scandal and people are scared.”UNAids is also concerned about the spread of the virus to the Pacific, with rising cases seen in Solomon Islands and Papua New Guinea. In November, Australia’s minister for foreign affairs, Penny Wong, announced A$48m for Pacific countries to fight HIV/Aids, while New Zealand committed NZ$4.2m to Fiji in July.
米切尔指出，作为预防艾滋病毒的药物，暴露前预防疗法的引入将带来“颠覆性改变”；他还补充称，对于感染风险较高的人群，可每六个月注射一次该药物。
The introduction of PreP – or pre-exposure prophylaxis – an HIV prevention drug, would be a “gamechanger,” says Mitchell, who adds that one injection could be offered every six months for those at higher risk.
对于难以向伴侣要求采取安全性行为的女性而言，这一疗法尤为重要。目前，每100名孕妇中就有2人感染了艾滋病毒。“药瓶难以隐藏，但注射剂却可以，”米切尔说道。
It would be especially important for women who are not able to push for safe sex practices with partners. Two in every 100 pregnant women now have HIV. “You can’t hide a bottle of pills, but you can get an injection,” says Michell.
目前，斐济已为孕妇提供三次艾滋病毒检测服务，三家主要医院也都设有生殖健康服务点。
For now, women are already being offered three HIV tests during pregnancy and sexual reproductive hubs are operating at the three main hospitals.
“应对艾滋病毒疫情没有捷径，不可能一蹴而就。遗憾的是，很多人误以为这就像新冠疫情一样能迅速解决，其实完全不是这样，”米切尔说道。
“There’s no miracles in the HIV response, it does not happen overnight. Unfortunately people are thinking this is like Covid, it’s very much not,” Mitchell says.
他的团队计划开设新诊所，将检测和治疗纳入全科医生服务，开展减害工作，并至少再招聘100名员工。他表示，病例增加意味着更多人接受检测，这是积极信号。
His team plans to open new clinics, integrate testing and treatment into GP services, work on harm reduction, and hire at least 100 more staff. He says that the increase in cases means more people are getting tested, which is a positive.
“职业倦怠是一个主要担忧——我们不是昨天才开始工作，已经工作了21个月。这很困难，困难在于这一切都是可以预防的。本不该发生。”但在许多地区，包括农村地区，治疗获取仍然滞后。无毒世界斐济创始人兼倡导者Kalesi Volatabu至今仍被六年前初次推动安全针具项目时遇到的那个15岁女孩所困扰。她是一名毒品运输贩，将冰毒走私至新西兰和澳大利亚，她给手背上的三条主要静脉起了名字：早餐、午餐和晚餐。
“Burnout is a major concern – we didn’t just start working yesterday, we’ve been working for 21 months. It’s difficult, and the difficulty is that all of it is preventable. It should not be happening.”But in many areas, including rural localities, access to treatment continues to lag. Drug Free World Fiji founder and campaigner Kalesi Volatabu is still haunted by the 15-year-old girl she met when she started pushing for a safe needle programme six years ago. A drug mule who smuggled methamphetamine to New Zealand and Australia, she had names for the three main veins on the back of her hand; breakfast, lunch, and dinner.
“我们完全不知道这个国家毒品交易的严重程度、深度，也不知道艾滋病危机。即使是我，起初也很天真，一切长期以来都未被报道。我们当时未能采取行动——现在我们会吗？”
“We had no idea of the severity, of the depth of the drug trade in this country, of the HIV crisis. Even I was naive, at the beginning, and everything was unreported for the longest time. We failed to act then – will we now?”
*姓名已更改
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