Your Excellency, Ratu Naiqama Lalabalavu, President of the Republic of Fiji. Honourable Minister for Health and Medical Services. Distinguished guests, community members, colleagues and dear friends.
It is a privilege to join you all here in Fiji for this Pacific HIV Symposium. I acknowledge the Government of Fiji as our hosts, and I pay my respect to the people, communities and traditional leadership of Fiji.
The strong regional attendance speaks to the need and value of the Pacific coming together on HIV. I acknowledge the people with lived experience, clinicians, community leaders and civil society organisations here today. Your voice, your expertise and your leadership are essential to an effective HIV response.
And I acknowledge the Australasian Society for HIV Medicine (ASHM) for the coordination of this event, and for bringing together such an important group of people from Pacific governments, clinicians, communities and technical partners. I have been a proud ASHM member for more than 35 years.
I have been asked to speak today about what Australia has learned from its HIV response, and how those lessons may support the work underway across Fiji and the broader Pacific. The message I want to leave with you all is simple. The Pacific has an opportunity to act now and change the trajectory of HIV through coordinated regional action. That opportunity is real. But it requires urgency, partnership, evidence and trust.
HIV is a shared regional challenge
We meet at a very serious moment. Across parts of the Pacific we are seeing rapidly rising numbers of people being diagnosed with HIV and related co-infections. Many systems are not yet prepared to handle the rise.
HIV does not respect our borders. In a region connected by family, faith, work, education and mobility, no country's response can stand entirely alone. This is why regional cooperation matters. It matters between health officials, justice, law enforcement, churches, community organisations and clinicians. It matters between Pacific countries. And it matters because the global health funding landscape has been changing. As financing shifts, including from the Global Fund, greater national ownership is required.
This does not mean countries have to act alone. It means national leadership supported by coordinated regional action, with partners working in ways that reinforce Pacific priorities.
One of the most important issues we must name clearly is stigma. Stigma is a driver of the epidemic, and lack of HIV literacy compounds that risk. Stigma and low HIV literacy are not side issues. They have been central drivers of this epidemic since the early 19802. Where people fear judgement or disclosure, they delay testing, avoid treatment and disengage from care. Testing must be voluntary, confidential and offered in ways that are safe, respectful and accessible. When people's rights are respected, they are more likely to seek testing, remain in care and access prevention services. This is a public health point as much as it is a human rights point. A response that protects dignity is a response that works for us all.
Lessons from Australia’s HIV response
In speaking about Australia’s response, I acknowledge my many colleagues from Australia at this symposium, from ASHM, Health Equity Matters, NAPWHA, the Kirby Institute, the Burnet Institute, the Doherty Institute, and many others, who have come here because they care, because they want to be available if and when support is needed, because they want to work as partners to make a difference in people’s lives.
Australia's HIV response, over the past four decades, has not always been perfect. No country's response to serious health emergencies ever is. But there are lessons that have mattered deeply that I wish to share with you.
The first is the importance of a people-centred approach. People living with HIV and key populations were engaged in Australia directly and early. Effective HIV responses work when the people most affected are not treated as a problem to be managed, but as partners in designing the solution. “Nothing about us, without us.” Supporting peer-led responses is an effective way to do this. Peer-led organisations build trust in ways that formal systems cannot always do alone. They help people understand risk, seek testing, navigate treatment and remain connected to care.
The second lesson is that good data leads to good decision making. Strong surveillance and reporting systems allow governments to see the epidemic clearly and target resources where they will have the greatest impact. But good data depends on trust. Increasing access to voluntary, confidential and stigma-free testing is essential if surveillance systems are to provide an accurate picture of HIV transmission. Testing is also the gateway to the HIV care continuum. People need to know their status before they can access treatment and achieve viral suppression. Data should guide action, but it must be collected and used with confidentiality and trust at the centre.
The third lesson is the importance of evidence-based responses. In Fiji, unsafe injecting practices have emerged as a driver of transmission. Responding effectively will require evidence-based approaches that address this reality. Facilitating safer injecting practices will be important to curb further HIV transmission, such as the establishment of needle and syringe programs to reduce the sharing of injecting equipment. These are often difficult conversations for communities and governments. Experience internationally has shown that addressing the drivers of transmission directly is essential to changing the trajectory of an epidemic. We have also seen the extraordinary impact of treatment as prevention. People living with HIV who are on effective treatment and achieve sustained viral suppression cannot pass HIV on through sex. This reinforces the importance of testing early, linking people rapidly to care, and supporting them to remain on treatment.
The fourth lesson is that sustainable responses are built into broader health systems and are locally led. HIV-specific expertise is essential, but the response must be embedded in sustainable health systems. Integration with primary care, sexual and reproductive health, antenatal testing and care, tuberculosis services, and other community services allows responses to endure. HIV has never been purely a health problem, and it has never had a purely health solution. A multi-sectoral approach is critical. HIV sits at the intersection of health, law, faith, gender and community, so the response has to sit there too.
One of the most important lessons I have learned is that HIV is never just about a virus or a diagnosis. It is about people, about families, relationships and communities. The experiences and resilience of people living with HIV have shaped my understanding of medicine and public health, and how to be a better doctor and a better person.
The most effective HIV responses are those built on genuine partnership. Lasting progress happens when communities and people with lived experience are trusted as partners, and their voices are placed at the centre of the response.
Prevention, treatment and long-term sustainability
Ongoing commitment and government investment are essential. While treatment enables people living with HIV to live long and healthy lives, it is a lifelong commitment for individuals and health systems. Prevention remains one of the most effective investments governments can make. Fiji has recently introduced access to oral PrEP and is preparing for the introduction of long-acting injectable prevention options. These advances have the potential to transform HIV prevention. But they work best alongside broader efforts to strengthen testing, treatment and community awareness. Every infection prevented reduces future treatment needs, lowers long-term costs and helps ensure health systems remain sustainable. New prevention tools, including long-acting pre-exposure prophylaxis (PrEP), are changing what is possible. The task before us is to ensure innovation reaches the people and places that need it most, in ways that are affordable, acceptable and sustainable. That means prevention must not be seen as an optional extra. It is central to protecting individuals, families, communities and health systems.
Encouragement and signs of progress
Although the challenges are serious, there are many good signs in the response so far. The Government of Fiji, for example, has recognised the seriousness of the challenge and has responded with leadership and commitment. There is growing recognition across the region that action now can prevent much larger challenges in the future.
Systems may be under pressure, but the dedication of the people working within them is our greatest asset. That dedication is visible in the frontline health workers, community leaders, researchers, officials and partners gathered here today. This Symposium is itself a sign of determination. It shows that this region understands the urgency, and that the nations and people of this region are prepared to work together.
Australia’s commitment to support Pacific-led HIV action
Australia is here as a partner to support Pacific-led action on HIV. As global health financing tightens, this region's need for strong domestic leadership and coordinated regional support is growing. Australia will continue to play our part, not as a substitute for national ownership, but as a trusted partner. Australia's support is intended to reinforce Pacific leadership, not replace it.
Australia has supported Fiji as part of an immediate response. Ten rapid assessments have been undertaken across other Pacific Island countries. Through the Australian Support for Pacific HIV Action investment of $48 million AUD, Australia is supporting Pacific-led HIV action through practical, responsive and sustained partnership. Through this investment, Australia is supporting national health systems, community-led responses and access to priority commodities. Our support will be guided by country priorities, evidence, and the leadership of Pacific governments and communities. This is the right way to work. Because durable progress will only come from Pacific-led solutions, strengthened by regional cooperation and supported by our respectful partnerships.
Conclusion
I want to close by returning to the opportunity before us, as this Symposium so clearly represents. The window for action is now. Case numbers in several Pacific countries are still low enough that a determined, coordinated response now can change the trajectory. The challenge is serious, but it is not beyond reach.
Pacific cultures carry strength. Family, community, faith, leadership and collective responsibility are powerful foundations for public health action. These strengths can help turn the tide on HIV if they are harnessed now to reduce fear and stigma, protect dignity, support confidential care, and ensure that no one is left behind.
The task facing us all is to bring together the best of what we know: evidence-based policy, community partnership, prevention-focused approaches and strong health systems. It is to listen to people with lived experience. It is to support clinicians and frontline health workers. It is to work across sectors and across borders. And it is to act now, while action can still change the future. If we do that, the Pacific can change the trajectory of HIV. Australia is committed to supporting that work, guided by Pacific leadership and grounded in respectful partnership.
In closing, I thank our sign language interpreters for making this session accessible. And I thank you all for the important work you are doing. Thank you.
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