HIV infection rates are raising fears that the Philippines will be faced with a public health crisis that it has long escaped. Since the Philippines reported its first case of HIV in 1984, the island nation has had one of the lowest rates of infection in the world; less than 1% of its 100 million population has been infected with the virus that causes AIDS. But that may be changing.

Globally, new HIV infections have fallen dramatically in recent years, according to UNAIDS, the United Nations’ program to combat the disease. But in the Philippines, more than 20,000 new HIV infections were reported from 2010 to 2015 — more than four times as many as had been recorded in the 26 years before that.

Along with India and Pakistan, the Philippines is seeing new infections and AIDS-related deaths sharply rise among men who have sex with men and among transgender women, sex workers and people who inject drugs.