For the full clinical picture — how PrEP works, daily vs on-demand dosing, side effects, and monitoring — see PrEP Mechanics: Daily, On-Demand & Injectable first.

The Bulgarian PrEP Situation

PrEP is not reimbursed by the National Health Insurance Fund (НЗОК / NHIF) in Bulgaria as standard. You pay for it privately. The good news: generic TDF/FTC (tenofovir/emtricitabine) is available at Bulgarian pharmacies at relatively low cost — typically 60–120 BGN per month (approximately €30–60), making it one of the more affordable EU countries for private PrEP.

There are ongoing advocacy efforts by Single Step Foundation and other NGOs to improve NHIF reimbursement — check singlestep.bg for any updates to the coverage situation since this was written.

Getting a Prescription

Route 1: Via Checkpoint Sofia / Single Step Foundation (Recommended)

Checkpoint Sofia and the Single Step Foundation network can refer you to doctors who are experienced in PrEP prescribing and non-judgmental about gay men's sexual health. This is the most reliable route to a knowledgeable prescriber. Contact them via singlestep.bg or their Checkpoint Sofia page.

Route 2: Infectious Disease Specialist (Инфекциолог)

An infectious disease specialist can prescribe PrEP. The SBALIPB (Специализирана болница за активно лечение на инфекциозни и паразитни болести), the main infectious disease hospital in Sofia, has specialists who work with HIV and prevention. However, the degree of LGBTQ+ affirmation varies by individual doctor — Checkpoint Sofia's referral network is more reliably affirming.

Route 3: Private GP or Specialist

Some private GPs and internal medicine specialists in Sofia will prescribe PrEP, particularly if you present with knowledge of the medication and clinical need. The private medical sector in Bulgaria is more accessible and often more flexible than the public NHIF system.

Getting the Medication

Generic PrEP (TDF/FTC) is available at pharmacies with a valid prescription. Brands vary — ask for the cheapest available generic.

Cost: 60–120 BGN/month (€30–60). Prices vary between pharmacies; it's worth checking a few.

No Prescription? Some gay men in Bulgaria have historically obtained PrEP via online pharmacies based in India or other countries. This carries risks (no monitoring, unknown quality) and is not recommended. The legitimate prescription route is accessible and affordable enough to be the right choice.

Monitoring

Regardless of how you access PrEP, proper monitoring every three months is essential:

  • HIV test (critical — PrEP taken during undiagnosed HIV creates resistance)
  • Three-site STI screen (throat, rectal, urethral — requires a private lab or specialist)
  • Kidney function (creatinine)
  • Hepatitis B status (at initiation and annually)

Checkpoint Sofia or a private laboratory are the practical options for monitoring in Bulgaria. NHIF-covered testing through the public system is inconsistent for gay men's specific needs.

On-Demand PrEP (2-1-1)

The 2-1-1 protocol — 2 tablets 2–24 hours before sex, 1 tablet the day after, 1 tablet the day after that — reduces both cost and drug exposure for men who don't have sex daily. Evidence-based and worth discussing with your prescriber. A doctor familiar with PrEP (via Checkpoint referral) will know it.

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