The Situation

Bulgaria has one of the higher HIV rates among EU member states and one of the more challenging LGBTQ+ environments. Stigma — around both HIV and homosexuality — is a real and documented barrier to care. The public health system can be inconsistent and sometimes unwelcoming. Against this backdrop, the community organisations — primarily Checkpoint Sofia and Single Step Foundation — are not just helpful, they are the system.

The headline facts: PrEP is not reimbursed — you buy generics privately at around 60–120 BGN/month (€30–60). PEP is available at SBALIPB (the Infectious Disease Hospital in Sofia). Testing is best done at Checkpoint Sofia or a private lab.

🗺️ The Bulgaria Guide Map

The Clinics

- Checkpoint Sofia (Tsar Samuil Street area, singlestep.bg) — free rapid HIV and syphilis, anonymous, LGBTQ+-aware. KABKIS for anonymous HIV testing via public system. Private labs for full three-site STI panel (~50–120 BGN).
- Plovdiv (УМБАЛ Св. Георги), Varna (УМБАЛ Св. Марина), other cities (nearest large public hospital). Very limited community infrastructure outside Sofia.

Prevention

- Not reimbursed. Via Checkpoint referral or private infectious disease specialist. Generic TDF/FTC at pharmacies: ~60–120 BGN/month. Marien Apotheke equivalent: ask Checkpoint for current reliable pharmacy.
- Mpox: limited availability — check singlestep.bg for current campaigns. Hep A/B: paid (~240–450 BGN total). HPV: free for school-age girls only; adults pay ~600–840 BGN total.
- No guideline. Via Checkpoint/Single Step referral to an aware specialist. Doxycycline itself ~10–25 BGN/month.

Emergencies

- SBALIPB, бул. „Акад. Иван Гешов" 17, Sofia. Walk in, say "Imam riskov kontakt s HIV — trqbva mi PEP." Coverage varies — go regardless of cost uncertainty. 72-hour window.

Support

- 112 for crisis, Single Step Foundation for LGBTQ+-aware support and referrals, private psychologists ~40–80 BGN/session. Stigma is a real and documented stressor — named and valid.
- Single Step Foundation as primary resource. Limited harm reduction infrastructure. PrEP is especially important in chemsex contexts given Bulgaria's higher HIV background rate.

Language

- Cyrillic and transliterated phrases for testing, PEP, PrEP, and hospital navigation. Key institutional vocabulary.

The Golden Rules

Rule 1: Single Step Foundation Is Your Anchor

For testing, PrEP referral, post-diagnosis support, and navigating a health system that can be hostile — start at Single Step Foundation (singlestep.bg) or Checkpoint Sofia. They know which doctors are affirming, which pharmacies are reliable, and what is currently available.

Rule 2: PrEP Is Affordable — Get On It

At 60–120 BGN/month (€30–60), generic PrEP in Bulgaria is genuinely affordable relative to the risk. In a country with higher HIV prevalence and a stigma environment that makes testing and treatment harder, being on PrEP is more important, not less.

Rule 3: For PEP — SBALIPB in Sofia, Immediately

Go to the Infectious Disease Hospital (бул. Акад. Иван Гешов 17) for PEP. Outside Sofia: nearest large public hospital. The 72-hour window is absolute. Do not delay over cost or stigma fears — go.

Rule 4: Expect to Pay, Plan Ahead for Vaccines

Bulgaria requires payment for most vaccines relevant to gay men. Hepatitis A/B and HPV are not subsidised. For mpox, current availability is limited — check Checkpoint Sofia / Single Step and consider timing vaccination during travel to a Western European country if needed.

Anonymous Partner Notification

If you test positive for an STI and absolutely cannot face the direct message (e.g., safety concerns, extreme anxiety), you must still ensure partners are warned.

Bulgaria does not currently have a centralized, public anonymous notification portal. The most effective route is to ask the clinic or doctor who diagnosed you to assist; many local sexual health units can facilitate confidential partner notification on your behalf without revealing your identity. It's always better than silence.

General Education

Bottom line: Start at Checkpoint Sofia / Single Step Foundation. Get on PrEP (60–120 BGN/month — affordable). For PEP, go to SBALIPB immediately. Expect to pay for vaccines and plan ahead. The stigma environment is real — the community organisations are your shield inside it.