Bulgaria is a country in southeastern Europe bordered by Greece, the Aegean Sea and Turkey to the south, North Macedonia and Serbia to the West, Romania to the North and the Black Sea to the east. Though the fight against HIV/AIDs in Bulgaria has had its ups and downs, the country has made substantial progress during the past 20 years in providing accessible treatment and diagnoses to its citizens.

Demographics

The prevalence of HIV/AIDs in Bulgaria is higher among men than women and new cases are most common in people 30 to 40 years old. By far the most common mode of infection for men and women is sexual contact, representing 89% of all new cases, while the remainder is mostly drug use by a needle. The rate of new cases is also drastically more likely in urban areas, 40% of all new cases being from the capital city Sofia alone. Al Although 17.7% of Bulgaria’s population resides in Sofia, this is still a much higher per capita rate than elsewhere in the country.

History

In 2004, The Global Fund, an international organization sponsored by many private and governmental agencies, provided Bulgaria with significant financial support to expand its fight against AIDS, tuberculosis and malaria. With this money, the Bulgarian Government expanded HIV/AIDs resources through its Health Ministry as well as sponsored many NGOs dedicated to implementing wide-reaching services for HIV/AIDs treatment and diagnosis.

While the steady increase in documented AIDs cases since the Global Fund’s intervention might make it seem as if the problem is actually getting worse, this apparent setback is just a result of more widely available testing and is not necessarily indicative of an increase in HIV/AIDs cases. In fact, these measures were largely effective and continue to contribute to the relatively low rate of HIV/AIDs in Bulgaria.

However, due to the country’s success, in 2014 the Global Fund determined Bulgaria was no longer eligible for aid and by 2017 the government spent the remaining Global Fund money. Due to these changes, many NGOs dedicated to fighting HIV/AIDs have either dissolved or shrunk, Politico reported. While the government is doing well in maintaining treatment and diagnoses for its citizens, NGOs were primarily responsible for reaching marginalized and impoverished communities with on-the-ground testing and prevention efforts and the extent of inclusion of these is difficult to determine.

On the Bright Side

The fight against HIV/AIDs in Bulgaria is largely successful even in the absence of Global Fund support. The rate of diagnoses is only 3.7 per 100,000 people as opposed to the EU average of 5.4 per 100,000 people, making it a success story among eastern European countries. Treatment of HIV/AIDs in Bulgaria is also a success with 98% of its infected population receiving antiretroviral therapy, a marked difference from the 68% world average, Radio Bulgaria reported.

Additionally, according to WHO, due to stigma as well as limited access to resources and transportation, many people simply will not or cannot access the treatment or testing they need. By using private, at-home tests, the experimenters sought to circumvent these factors and it showed many people who otherwise would not have had access utilized the at-home option. Projects like this foreground a bright future in the fight against HIV/AIDs in Bulgaria.

Lastly, after observing several similar instances of countries struggling to transition to the absence of support from the Global Fund, the organization revised its policy to account for an adjustment period. These revisions include “investing in the development of robust National Health Strategies, Disease Specific Strategic Plans… and requirements to ensure that Global Fund financed programs can be implemented through country systems.” With these changes, countries dealing with the same process in the future could be better able to maintain their fight against HIV/AIDs.

– Xander Heiple
Photo: Unsplash