In June 2020, all harm reduction services with public funding stopped in Bulgaria for the second time in three (2017-2020) years. The oldest, biggest, and most experienced harm reduction organisation, Initiative for Health Foundation, shut down too. No needle and syringe programs remained open in the country. An article by Yuliya Georgieva.
The story starts in 1997 when Initiative for Health Foundation was founded, becoming the first harm reduction program in Bulgaria. During the next several years they supported and trained two more organisations. “Dose of love” in Burgas and “Panacea” in Plovdiv. They are the pioneers, the people who covered all HIV prevention for people who use drugs (PWUD) during the huge and awful heroin epidemic in the ‘90s.
The heroin epidemic started to fade away after 2003. The Ministry of Health signed a contract with the Global Fund. Three NGOs, including Initiative for Health Foundation, were appointed to be the mentors for the newly founded organisations which needed to work in the field.
The National HIV program encouraged the creation of new organisations to be the grantees of Global Fund grants. Armed with a lot of money and political support, the National HIV program became the architect of making these new NGOs friendly and silent allies. Initially, the staff of these organisations were emotionally motivated. But the Ministry broke their independence and strong motivation and made them into technocrats.
Approximately 50 organisations have received Global Fund funding through the National HIV program for more than 10 years. During this period Bulgaria became one of the most successful countries regarding HIV prevention. The reports were amazing, the epidemic in the biggest ghetto in Europe (Stolipinovo-Plovdiv) was stopped. The results seemed very, very good.
At the same time, the majority of the NGOs were fully subordinated to the Ministry. The representatives of the National HIV Program were recognised as important allies by the Global Fund and on the international level, and became the main source of information.
In 2014, the Global Fund finished its mission to fund HIV prevention efforts in Bulgaria. On the 13th of February 2015, 40 organisations launched a campaign by signing a manifesto for ensuring sustainable funding for harm reduction activities by the national government. The campaign in parliament was successful and the manifesto was supported by all parliamentary groups. As a result, the Ministry of Health ensured a 3 year extension, with the support of the Global Fund. Decision makers promised to provide sustainable national funding but they did not make a signed commitment. Again, it was a brilliant bureaucratic decision to silence free NGOs, dependent on the funding of the National HIV Program.
After 2014 some of the NGOs supported by the National HIV program closed down and/or stopped their HIV related activities.
In July 2017 all harm reduction activities were stopped for the first time because of the lack of funding.
In November 2018 the public tender for harm reduction was opened again for only 4 Bulgarian cities. The budget was €180,000. It was not enough to cover all HIV prevention for the most vulnerable groups – people who use drugs, men who have sex with men, people who live with HIV, and sex workers. It was almost impossible to ensure adequate services. But some of the organisations tried.
After two years interruption, the services started again in July 2019 – but only in Sofia, Plovdiv, Varna and Burgas and only for a year. In Sofia Services registered three times more HIV positive PWUD than during the previous working year.
The contracts ended at the end of July 2020. The new public tender has not opened yet and it doesn’t seem likely it is going to happen at all during the COVID 19 crisis. The whole procedure usually takes at least 7 months, which means that even if the Ministry of Health opened the new procedure now the activities would not have a chance to start until spring 2021.
The previous public tender has a clause that the applicant organisations need to ensure warranty of 3% of the amount and to ensure the funding for the services for the first four months of the period. (This money will be returned by the Ministry of Health after the first report has been approved.
This is beyond the strength of all the harm reduction organisations at this moment. Meanwhile the Bulgarian National Drug strategy was adopted today (29/07/2020) after two years delay, with harm reduction barely mentioned in the strategy. The action plan and the budget are not public yet.
The National HIV strategy will end at the end of 2020. The work of preparing the new National HIV strategy has not started yet. All funds for all HIV activities depend on the budget put in the strategy. Meanwhile the NGOs have been forced to lay off most of their employees, close their offices, and even shut down their organisations entirely.
The only working harm reduction facility for PWUD in Bulgaria (Sofia) is the Pink House – the drop-in center run by the Center for Humane Policy, which covers its costs mainly by individual donations.
| As of 1st of July 2020, Bulgarian harm reduction can be declared dead. |
Yuliya Georgieva
