Striving for equality – World AIDS Day 2022

Numerous organizations and activists are celebrating World AIDS Day on 1 December against the backdrop of new challenges of the times, but also the successes we are achieving. There are several major challenges in the fight against the virus in Bulgaria:

• Inaccessibility of testing for HIV and other sexually transmitted infections
• The steady decline in HIV testing over the last 3 years
• Late diagnosis of people living with HIV - years after becoming infected

Driven by solving this fundamental problem in the fight against HIV, the Single Step Foundation, through its long-standing #endHIVbg program, advocates for the promotion of home testing to allow every citizen to know their HIV status. In 2018, we piloted a home testing campaign for the first time and continued to offer free home testing from 2020-2022, especially thanks to the support of the WHO national office.

After hard work over the past years, we are announcing that home HIV tests will soon be available in the pharmacy network across the country. This is possible thanks to our numerous partners over the years and especially the Bulgarian biotech company Ridacom.

The other good news at the end of this year is that those wishing to use HIV pre-exposure prophylaxis (PrEP) will soon benefit from a national policy in this direction. The Ministry of Health, through a working group, is developing national recommendations for PrEP that will cover discharge and follow-up procedures, including for sexually transmitted infections. We expect this guidance to make PrEP much more accessible, thereby reducing the prevalence of HIV among the group of men who have sex with men.

For the second year in a row, on 1 December 2022, World AIDS Day, the French Institute in Bulgaria has hung a red ribbon flag in solidarity with all victims of the disease and all those fighting to eradicate it. The red ribbon represents the motto #endHIVbg in a sign of the united efforts to end the HIV epidemic in Bulgaria. Expressing international solidarity against this pandemic is a natural thing for the Institute, which with all its activities promotes the values of equality, freedom, humanity and solidarity.

This day provides an opportunity to raise awareness, honour the dead and pay tribute to successes such as increased access to treatment and prevention services. Having achieved the global goal of reducing the spread of HIV and turning the tide, world leaders have set "fast-track" targets to scale up action against HIV and "end the AIDS epidemic" by 2030.

At a time when data reveals the slowing progress in the fight against the HIV pandemic and declining resources over the past two years marked by COVID-19, this year's motto is "Striving for Equality". It reminds us that the unequal access to the most basic services and new technologies that sustains the AIDS pandemic is not irreversible. It calls us to action. It urges us all to take concrete actions that have been proven to work and that are necessary to combat inequalities and end AIDS. These include:

• Strengthening access and quality of HIV treatment, testing and prevention services so that everyone has adequate access. Soon, all Bulgarian citizens will have access to home HIV testing thanks to the longstanding efforts of the Single Step Foundation.
• Change regulations, policies and practices to address the stigma and isolation faced by people living with HIV and key and marginalised populations so that every individual is respected and welcomed.
• Ensure that technology is shared across communities and continents to allow equitable access to the best scientific findings on HIV.

From 1986 to 25.11.2022, a total of 4 020 persons with HIV infection have been registered in Bulgaria. Since the beginning of 2022, 299 new HIV-positive persons have been detected. The trend of recent years has been maintained that the number of newly registered men is higher than that of women. The male/female ratio continues to increase this year at 8:1.

According to preliminary data, more than 232 088 persons were tested for HIV in the first ten months of the year. The challenge of accessibility to HIV testing remains as the number of tests carried out has dropped dramatically due to the COVID-19 pandemic. In 2019, over 350 000 tests were done in Bulgaria, in 2020 the number drops to just over 270 000, and in 2021 the number is below 260 000.

The Ministry of Health provides free antiretroviral therapy to all people in need, regardless of their health insurance status. The use of antiretroviral therapy prolongs patients' lives and improves their quality of life. As of October 31, 2022, a total of 2,160 persons with HIV are being followed in the five HIV/AIDS treatment sectors, and 2,129 (99%) of them are receiving modern antiretroviral therapy.

Bulgaria remains a country with low HIV prevalence - the incidence of new HIV infections per 100,000 population for Bulgaria is 2.9 in 2020, compared to the EU average of 3.3.