In Bulgaria, harm reduction as a public health objective is addressed in the Narcotic Substances and Precursors Control Act and the terms and conditions for implementing harm reduction programmes are set out in the regulation that was issued by the Minister of Health in 2011.
In 2015, a network of 10 non-governmental organisations (NGOs) provided harm reduction programmes at 61 fixed sites located in 18 towns across the country, which represented a decrease compared with 2014. Funding of the harm reduction network in the framework of the HIV/AIDS Control and Prevention Programme was financed by the Global Fund to Fight AIDS, Tuberculosis and Malaria; this funding ended in 2015.
In addition to providing services to people who inject drugs (PWID), these NGOs also address the needs of other high-risk groups, such as drug users of Roma origin and sex workers. According to official regulations, harm reduction programmes provide information on safe injecting methods, overdoses and infectious diseases; they also undertake testing for blood-borne infections and supply sterile injecting equipment. Services are provided through outreach work, mobile medical consulting rooms and drop-in centres. However, the extent of the services provided varies by site.
In the last few years, service providers report that heroin is becoming less prevalent among their clients and that other psychoactive substances, such as OST medications or NPS, are injected instead. In addition, the proportion of clients at low-threshold facilities who inject stimulants has been increasing. In 2015, an estimated 364 000 syringes were distributed through specialised agencies and outreach programmes, which is fewer than in 2014.
Availability of selected harm reduction responses
NBYear of data 2016.
Ten NGOs, the NCA and medical services in the bigger towns provide anonymous HIV counselling and testing.
There has been no publicly funded HBV vaccination campaign for the target group of PWID since 2000, despite the fact that the current action plan of the National Strategy to Combat Drug Addiction identifies this as one of the sub-tasks necessary to reduce the prevalence of infectious diseases among PWID. In Bulgaria, a mandatory immunisation of all new-born babies has been in place since 1993.
The proportion of clients at low-threshold facilities who inject stimulants has been increasing