CEBU CITY, PHILIPPINES—The dealer’s hands move quickly as he dispenses small vials from the waistband of his shorts, his front pockets bulging from the weight of coins and small bills. From his back pocket, he hands out syringes or collects them. Occasionally, he uses the t-shirt slung over his shoulder to wipe away the beads of sweat that made his goatee glisten.

The shanty where he works—a small room full to bursting with people—is home to one of Cebu’s many “shooting galleries,” a place where people gather to purchase and inject the narcotic pain reliever Nubain. At this particular gallery, a small glass capsule containing 1 mL goes for Php 150, or around $3. For individuals on a tighter budget, the dealer can squeeze out a single squirt for Php 20 ($0.50). Those who bring their own supply of the drug only have to pay a fee to use the shooting gallery, a charge of Php5-Php10 ($0.10 - $0.20).

An unused needle sells for another Php20 ($0.50), but few people who came through the shooting gallery chose to purchase one—the dealer also supplies free “service needles,” new and slightly used syringes on rotation that any customer can use. It’s common for groups of customers to split the cost of a vial of Nubain between them, and share a service needle as they use it. The Philippine Department of Health (DOH) says that the typical shooting gallery has three to five service needles on rotation at a time, each of which can be used four to six times before it gets too blunt. According to Genesis Samonte, the head of the department’s HIV surveillance unit, one shared needle can infect four to six people with HIV or hepatitis C.

Veejay Villafranca

Public-health experts say shooting galleries like this one are to blame for the high rate of HIV in Cebu City, one of the highest in a country that’s already struggling to combat the virus—even as new infections have declined worldwide, they’re on the rise in the Philippines. (In most other parts of the country, the primary means of transmission is sexual contact rather than drug use). In October, the DOH reported a total of 29,079 HIV infections in the country. More than 24,000 of those cases were detected in just the last five years. At this current rate, the DOH predicts that the number of HIV infections in the Philippines could reach 133,000 by 2022.