6. Combat HIV/AIDS, malaria, other diseases
The sixth Millennium Development Goal is also about human health and aims to limit the spread of HIV/AIDS, syphilis and tuberculosis. The spread of HIV/AIDS in Bulgaria is still under control and remains under the epidemiological threshold of 1%. The number of registered HIV cases, however, has increased threefold from 2002 up to 814 at the end of 2007, of which 125 were recorded since January 2007. Particularly alarming is the spread of HIV/AIDS among young people under 25 years (who accounted for 36% of the reported new cases in 2007).
The current epidemiological situation in Bulgaria, the neighboring Black Sea countries and Western Europe indicates there is a serious danger of concentrated epidemic outbreaks among injecting drug users, men having sex with men and prostituting men and women. Therefore, two new indicators will be added – tracking HIV prevalence among injecting drug users and men having sex with men.
The objective is to limit the spread of HIV under 5% in each group. The main goal of the national HIV/AIDS policy is to prevent an epidemic. To measure progress against that goal, Bulgaria is tracking HIV prevalence among one of the target groups in the national policy – young people aged 15-24, who are indicative for the entire population. Urgent and effective measures for prevention, health promotion and health and sexual education of young people are required, if Bulgaria is to keep the spread of HIV in that age group under 1%.
Syphilis morbidity in the EU and in Bulgaria characteristically shows cyclic dynamics caused primarily by changing patterns of sexual behavior. After a peak in 1990-2000, syphilis morbidity began to subside, down to 7.7/100,000 in 2005 and 6.6/100,000 in 2006. Reducing new cases of syphilis to 5 per 100,000 by 2015 is a realistic goal. It will depend on several factors – limiting the spread of syphilis among the highest risk groups (injecting drug users, prostituting men and women and young Roma men) and limiting the cases of congenital syphilis, which lately have alarmingly increased.
Like in most European countries recently, the spread of tuberculosis in Bulgaria has been increasing. Tuberculosis incidence was 25.9/100,000 in 1990 and 40.1/100,000 in 2005. In comparison, in 2005 average tuberculosis incidence in EU-27 was 19 per 100,000. Another indication is that WHO has defined Bulgaria as one of the 18 high TB priority countries in the European region, where an average of 79 new cases per 100,000 require urgent and effective measures for limiting the spread of the disease.
The epidemiological situation in Bulgaria shows that the goal to halve tuberculosis cases down to 20 per 100,000 persons in 2015 is overambitious and should be revised with the more realistic target of 22/100,000. Key factors contributing to the resurgence of tuberculosis include the appearance of extremely resistant forms of the disease, the fast increase in HIV cases, and the growing numbers of most-at-risk people. In 2007, the government launched a new National Program for Tuberculosis Prevention and Control in Bulgaria (2007-2011) and a Program for Improving TB Control in Bulgaria financed by the Global Fund to Fight AIDS, Tuberculosis and Malaria.
These diseases are connected with the overall state of society and can hardly be addressed by health means alone – the problems of the most vulnerable groups of injecting drug users, prostituting men and women, people with low incomes and poor education, interlink in several Millennium Development Goals. They require a concentrated and coordinated national response.
