Mark Lal had already seen three friends die of HIV before he received his diagnosis.
When he tested positive for the virus, he knew what could come next.
"They started to lose a lot of weight, [their] organs were failing," he said.
"Their deaths were eye-opening for me."
His journey since his diagnosis has been different, as he receives medical treatment that controls the effects of HIV.
But it hasn't been easy for the 23-year-old Fijian.
"When I found out and I isolated myself, it felt like the ground opened and I fell in and it just closed on me," he said.
It's an increasingly common story in Fiji, where the rapid growth in HIV cases jolted the government into declaring an outbreak in January.
While the country is scrambling to stem the increase in infections, the numbers have been staggering.
Fiji health authorities recorded more than 1,000 cases last year, three times as many as in 2023, and a nine-fold increase on the number recorded in 2019.
According to the UN, it's the second fastest-growing HIV epidemic in the Asia-Pacific region, after the Philippines.
And it's believed that with many cases going undetected, official numbers don't capture the true size of the outbreak.
Alipate Vakamocea, president of the Fijian Medical Association, is alarmed by the growing pace of infections and fears the health system isn't keeping up.
Half of all people in Fiji with HIV are not receiving treatment nor contactable, say health authorities, making it even harder to contain.
Dr Vakamocea said doctors had long been trying to draw the government's attention to the outbreak.
"They've been yelling and yelling, and there doesn't seem to be much happening," he said.
HIV cases surge as meth hooks Fiji's young people
The outbreak goes hand-in-hand with Fiji's growing drug scourge, with some 50 per cent of new cases caused by intravenous drug use, according to the Ministry of Health.
As Australia-bound methamphetamine passes through the Pacific Island nation on international drug routes, it spills over into the local market.
Meth use is spreading among Fiji's teens and young adults, and media reports say that on the streets of Suva, syringes loaded with methamphetamine sell for as little as 10 Fijian dollars ($7).
The surge in addiction is overwhelming local health services.
Dr Vakamocea says Fiji's only psychiatric facility, St Giles Psychiatric Hospital, is "getting swamped with addicts" seeking help, including primary school-age children.
He said people as young as 13 were contracting HIV through intravenous drug use.
Health authorities also warn the alarming practice of "bluetoothing" is exacerbating the problem.
It involves drug users sharing their high after injecting meth by drawing their own blood back up the syringe for someone else to inject.
"It's a practice which is really dangerous when we're thinking about not just HIV, but other communicable diseases, because it's taking one person's blood and putting it into another person's body," Michelle O'Connor, global division director of health worker peak body ASHM, said.
Dr Vakamocea said the wave of new cases from Fiji's growing intravenous drug use had confounded a health bureaucracy that had been focused mainly on controlling the spread of HIV through sex.
"When you really drill down into the statistics, what you realise is this particular surge, the outbreak has been driven by [intravenous drug use]," he said.
"The Ministry of Health system was designed to monitor and treat HIV/AIDS just within certain high-risk groups.
"It was never really designed to cater for a surge like [this]."
'Failed' health system 'playing catch-up'
On a sunny morning in Fiji's capital Suva, a group of volunteers hands out T-shirts carrying messages encouraging safe sex.
They are preparing for a rally to create awareness about sexual health — part of a new National Condom Campaign launched by Fiji's Ministry of Health.
There are also plans to establish 63 condom dispenser sites.
The campaign is one of a growing number of measures health authorities are taking as the enormity of the HIV outbreak grows clearer.
Fiji's Health Minister, Ratu Atonio Lalabalavu, announced a 90-day plan to tackle the surge in infections, focusing on acquiring more medications, and increasing prevention efforts including more testing.
"We have a lot of catching up to do, a lot of things to improve on and that is part of the 90-day plan," Dr Lalabalavu said.
While messaging about HIV across Fiji is becoming more visible, experts say the ministry is playing catch-up.
Renata Ram, country director for the joint United Nations Program on HIV for the Pacific, said Fiji's HIV response was "at least 15 years lagging behind".
It lacked preventive drugs like PrEP and had only limited HIV testing, she said.
She said testing should be available at any health service.
"Unfortunately, that's not the case. And even getting same day initiation on treatment, this is not possible given the limitations we have within Fiji," Ms Ram said.
Health experts warn that many cases remain undetected, and Dr Vakamocea said this was leading to a high number of preventable HIV transmissions, especially between mothers and newborns.
Nearly 20 newborn children were diagnosed with HIV last year, he said.
"That means your system has failed, it has collapsed," Dr Vakamocea said.
Many people getting tested leave false contact details and cannot be traced or managed by health authorities if their results are positive for HIV.
Dr Lalabalavu said one reason was that people viewed the virus as untreatable.
"We still equate HIV to something that's probably a death sentence, but HIV is treatable," he said.
"We have treatment available [and] it is free."
But Dr Vakamocea said Fijian health authorities had much to improve in their response to the outbreak — including rolling out testing and treatment kits, and going into the community to locate where cases were occurring.
"That's something that was never really built into the HIV strategy for the Ministry of Health and that's why we're struggling and where we are today," he said.
Fiji is yet to adopt measures used overseas to control the spread of HIV, such as needle exchange programs, and making clean needles and syringes available to high risk groups.
"That can reduce HIV. Those kinds of risk mitigation strategies are important," Dr Vakamocea said.
"Now, when you're talking about the mental health aspect of the intravenous drug users … we have nothing, we've literally nothing."
Breaking a deadly silence
Mark Lal's partner has supported him to manage his illness and seek help.
But others close to him received the news of his diagnosis differently.
When he told his parents he had HIV, his mother cried.
His father later disowned him, when he went public with his HIV status in December.
"My dad comes from a very strict Indian background. I think there was a form of embarrassment when it was in the papers," Mr Lal said.
His dad called him and said he "shouldn't be in contact any more" with the family.
Mr Lal — who did not contract HIV through drug use — has since made amends with his mother and still holds out hope of repairing his relationship with his father.
For him, going public with his diagnosis was all part of helping Fiji address its HIV outbreak — by raising awareness.
Mr Lal said there was a taboo that stops people talking about sexual health, forming a barrier to preventing HIV.
"People are having sex … and no-one actually talks about it," he said.
That may be starting to change.
The intensity of the stigma around sex and HIV in Fiji makes the recent condom rally in Suva all the more remarkable.
It's a step toward a more open discussion about HIV and sexual health.
But unless the drug crisis is addressed, it's likely cases will continue to rise — and with that comes a warning for the rest of the Pacific, experts say.
Despite the challenges, Fiji's health system is among the best in the region.
Experts warn that other Pacific nations could be experiencing a surge in HIV that is yet to be detected.
Dr Vakamocea said those nations needed to wake up, or they would see public health impacts of HIV and AIDS "that they have no idea how to address".
"Our Pacific Island neighbours would definitely have to take a page out of our book and start setting up those systems, otherwise they're going to get a shock," he said.
[YouTube HIV outbreak]
