Official Bulgarian statistics say that there are 926 Bulgarians with HIV but this is widely regarded by experts as inaccurate and that the figure is somewhere between 3000 and 4000, most of whom are not aware of their HIV status.
According a report by the World Health Organisation's regional office for Europe, 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 to 2006 that had a known mode of transmission (98 per cent), 80 per cent had been transmitted through heterosexual
contact, 10 per cent through injecting drug use, seven per cent through MSM, two per cent through blood transfusion and 0.9 per cent through vertical transmission.
In 2006 the transmission pattern shifted, with a higher proportion of HIV infection transmitted through injecting drugs (38 per cent) and MSM (11 per cent), and a decrease in heterosexual transmission (51 per cent)
About 69 per cent 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 per cent among IDUs, 0.73 per cent among SWs and 0.30 per cent 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 per cent of IDUs, 13.4 per cent of Roma people and 8.7 per cent of SWs are seropositive for hepatitis C, while the syphilis prevalence among the three groups is 2.4 per cent, 6.7 per cent and 21.5 per cent, respectively.
A total of 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 three facilities in Bulgaria. Of the patients on HAART, 70 per cent were infected heterosexually, 21 per cent MSM, three per cent IDUs, three per cent MTCT and two per cent were prisoners. Four out of the five 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.
A total of 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.
About 109 668 people were tested for HIV in Bulgaria during 2006.
A total of 265 PLHIV had been tested for co-infection with hepatitis and among these nine were co-infected with hepatitis B and 27 with hepatitis C. A total of 35 people were diagnosed with TB/HIV co-infection by the end of 2006.