Bulgaria (pop. 7 671 000)

By the end of 2006, Bulgaria had reported a cumulative total of 689 HIV cases, including 180 diagnosed as AIDS and 64 deaths among AIDS cases. The annual number of newly reported HIV infections grew from 15-20 in the early 1990s to 91 in 2006, reaching the highest reported annual case-reporting incidence since the beginning of reporting.

Among the HIV cases reported from 1986 through 2006 that had a known mode of transmission (98%), 80% had been transmitted through heterosexual contact, 10% through injecting drug use, 7% through MSM, 2% through blood transfusion and 0.9% through vertical transmission.

In 2006 the transmission pattern shifted, with a higher proportion of HIV infection transmitted through injecting drugs (38%) and MSM (11%), and a decrease in heterosexual transmission (51%)

69% of Bulgaria's reported HIV cases are male. In 2004 the largest numbers of cases were registered in four major cities, Sofia (163), Bourgas (72), Varna (39) and Plovdiv (40)
An initial round of second-generation sentinel surveillance surveys among three risk groups - IDUs, sex workers (SWs) and the Roma people - was conducted in late 2004 in five major cities: Sofia (the capital), Varna, Bourgas, Plovdiv and Pleven. HIV prevalence in the three groups was 0.59% among IDUs, 0.73% among SWs and 0.30% among the Roma population. Although the data indicate that prevalence among these risk groups is still low, their vulnerability appears to be high. Surveillance data show that 63.9% of IDUs, 13.4% of the Roma and 8.7% of SWs are seropositive for hepatitis C, while the syphilis prevalence among the three groups is 2.4%, 6.7% and 21.5%, respectively.

280 HIV/AIDS patients received medical care for their condition in 2006. By the end of 2002, 86 people were on HAART treatment and as of December 2007, a total number of 221 received HAART at 3 facilities in Bulgaria. Of the patients on HAART, 70% were infected heterosexually, 21% MSM, 3% IDUs, 3% MTCT and 2% were prisoners. 4 out of the 5 IDUs receiving HAART also received opioid substitution therapy (methadone).

Provision of antiretroviral therapy is covered by the budget of the Ministry of Health and is provided free-of-charge for all patients, who meet the criteria of the European treatment guidelines.

134 facilities across Bulgaria provide HIV testing and testing is free of charge. According to national HIV testing policies, partner notification was not mandatory. Pregnant women are systematically offered an opt-in HIV test and additionally systematic provision of VCT is offered to most-at-risk groups including sex workers, prisoners, young Roma, MSM, IDUs etc. All tests were reported to have been preceded by informed consent. Around 109 668 people were tested for HIV in Bulgaria during 2006.

265 PLHIV had been tested for co-infection with hepatitis and among these 9 were co-infected with hepatitis B and 27 with hepatitis C. 35 people were diagnosed with TB/HIV co-infection by the end of 2006.

Updated 18 June 2008

References:
European Centre for Epidemiological Monitoring of AIDS (EuroHIV). HIV/AIDS surveillance in Europe. End-year report 2006. Saint-Maurice: Institut de Veille Sanitaire, 2007. No. 75.

WHO Regional Office for Europe. Sexually transmitted infections/HIV/AIDS programme. WHO/Europe survey on HIV/AIDS and antiretroviral therapy 2006. WHO: Copenhagen; 2007 .