It is not easy to be HIV-positive in Bulgaria. From a medical point of view, there is backup – people who are HIV-positive get free-of-charge diagnosis and treatment even if they have no health insurance. However, the societal aspect is more complicated. The level of awareness about how the infection is transmitted, and the possible consequences, is low.

This means that, for fear of being stigmatised and marginalised, HIV-positive people in Bulgaria very often do not disclose their health status to their employers, families and friends.

Against this background, the Health Ministry’s 2007 anti-AIDS campaign is to focus on young people, to increase their knowledge about AIDS and how to prevent infection.
The theme of the campaign is Budi v Chas! (Бъди в Час!, Be on Time!), which is the Bulgarian expression for “to keep informed”.

The situation
The number of officially registered HIV-positive people in Bulgaria by November 22 this year was 803. Health Minister Radoslav Gaidarski, speaking at a November 27 news conference, said that it was expected that this number would increase to about 810 to 815 by the end of the year.

In 2007 alone, 114 people were newly registered as HIV-positive.

Gaidarski said that there were two unfavourable tendencies in Bulgaria.

“The first is that the (average) age of infected people fell to 16 years old. The second is that the two most endangered places are the main Bulgarian cities Sofia and Plovdiv,” he said. Sofia and Plovdiv accounted for 70 per cent of those reported as infected in 2007, In Sofia, the number was 36 and in Plovdiv 43.

More than 200 000 Bulgarians had HIV tests at Regional Inspectorates for Public Health Protection and Control (RIPHPC) laboratories and at other centres that offer testing.

In Bulgaria the main means of transmission is sexual contact. About 83 per cent of cases were through this means of transmission. In 2007, the rate of cases of HIV following homosexual contact increased, followed by infections through intravenous drug use – 13 per cent – while about three per cent were infected through blood and blood-products transfusion, and less than one per cent were through mother-to-child transmission. Currently, there are six babies reported as HIV-positive, The country has strengthened its pregnant women early diagnosis, treatment and infection prevention in general, and this is believed to have led to a decrease in the number of babies born with the HI virus.

In 2007, 95 men and 19 women registered with the Health Ministry as HIV-positive, which translates into 83.3 per cent men and 17.5 per cent women. Up to the end of 2006, 67 per cent of those infected were men and 33 per cent were women, which means that the new figures show a large increase in the number of HIV-positive men.

Gaidarski said that during 2007 the age range of the newly registered infected people had been very broad, as the youngest was 16 years old and the oldest 68. The youngest was infected through re-use of needles in intravenous drug-taking, while the oldest man got the disease through sexual contact. A troubling fact is that 35 per cent of newly registered HIV-positive people in Bulgaria are younger than 25.

The most vulnerable groups in the country appear to be intravenous drug users (36 per cent of all registered in 2007) and men who said that they had sexual contacts with men (24 per cent of the newly registered). There is a trend of an increasing number of intravenous drug users being found to be HIV-positive. The statistic goes back to 1986; between then and November 22 2007, the total number of intravenous drug users infected reached 105 people.

The Health Ministry, in co-operation with the Justice Ministry, has started a campaign to test all prisoners in Bulgaria’s13 state prisons, anonymously and voluntarily. The campaign began in the middle of 2006 and since the beginning of 2007 it is done once a week. So far 3654 people have been tested. Gaidarski said that of this group, 17 had been found to be HIV-positive.

In the first half of 2007, a total of 19 605 people were tested at the recently-opened 19 Laboratories for Anonymous and Free Diagnosis and Consultancy of HIV/AIDS (LAFDCA). Since these laboratories were established, 59 475 people have been tested there. About 60 per cent of people newly registered in 2007 as HIV-were diagnosed by non-governmental organisations (NGOs) and at LAFDCA.

The programme
Gaidarski said more than 40 NGOs were financed by the Health Ministry’s Prevention and Control of HIV/AIDS programme. According to an agreement between Bulgaria’s Health Ministry and The Global Fund against AIDS, Tuberculosis and Malaria, Bulgaria receives a grant for the implementation of the programme. For the period 2003-2005, the amount granted for the first phase of the implementation of the programme was $6 894 270. For the next three years, Bulgaria will get $8.8 million for the implementation of the second phase of the programme. The Global Fund grant is provided to the Health Ministry. It is controlled by the members of the Cabinet’s National AIDS committee, representatives of the United Nations Development Programme, academic and non-governmental organisations, which have formed the Bulgarian Country Co-ordinating Mechanism, which has 27 members.

This programme is the largest preventative health programme in Bulgaria. It aims at HIV prevention among the most vulnerable groups: intravenous drug users, men and women sex workers, Roma people, young people; and to assist people already living with the infection.

More than 650 consultants, specialists, collaborators and health specialists are involved in various programme activities. The number of people trained within the programme, including medical specialists, social workers, collaborators in the areas of working with affected groups, teachers, psychologists and young people, is 2622. Partners in the initiative, besides the 40 NGOs, include 138 schools, 12 RIPHPC, the National Centre for Infectious and Parasitic Diseases and many other health institutions. Furthermore, there are 10 local AIDS co-ordination offices in the municipalities of Blagoevgrad, Bourgas, Vidin, Varna, Pazardjik, Pleven, Plovdiv, Rousse, Sofia and Stara Zagora.

Work in schools
About 5059 new students from the 138 schools working on introducing health education in schools were included in the health educational groups in 2006 and 2007. Health education is a voluntary option in schools. The Health Ministry said that a further 53 744 young people were reached through different activities aimed at HIV prevention, within the framework of small school and social projects, campaigns for health promotion and condom distribution.

Children from three schools in Sofia contributed to the creation of a useful, colourful and easy-to-read “HIV/AIDS Notebook” (pictured right), which will be distributed during the Budi v Chas! campaign.

The campaign
The November 27 start date of the Health Ministry’s new campaign was chosen because of its proximity to World AIDS Day – December 1. It will take place in three key stages, the remaining two of which are connected to February 14, St Valentine’s Day, and the third Sunday of May, celebrated throughout the world as International Day for Compassion with the HIV/AIDS Infected. Budi v Chas! aims at broadly informing the youth and society in Bulgaria to increase people’s knowledge’s about the disease, about decreasing the risk of infection by routine use of condoms and of limiting sexual contact to trustworthy partners who have been tested and found to be HIV-negative.

There is no risk of infection through normal everyday contact with HIV- positive people, and nor is there any risk through mosquito bites. The campaign’s most important message is that a person who appears completely healthy could be an infected with the HIV virus, which means that condoms must always be used in any sexual contact.

More information is available at www.aidsprogram.bg, which has Bulgarian and English versions.