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.

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.