The trends of HIV transmission in the Pacific Islands reveal that transmission is steadily continuing despite any responses, women are more likely to be infected at younger ages than men, and more of them are being infected than ever before. This report stresses that HIV programs in the Pacific Islands do not adequately incorporate gender relations and social structures fundamental to understanding and preventing transmission. This report details the Pacific Islands’ gender vulnerabilities, cultural norms, policy and strategy challenges that allow the virus to continue to spread and recommendations on how to halt the transmission.