Abstract

PIP: The alarming increase of STDs, particularly syphilis (from 378 cases in 1990 to 2520 cases in 1997), has been identified as a high priority area in Bulgaria, where Doctors Without Borders has been working since 1997. In July 1998, DWB Switzerland set up a pilot project that supported the implementation of an innovative treatment procedure and encouraged the Bulgarian Minister of Health to adopt a new ordinance on syphilis treatment. The treatment procedure is recommended by WHO and is based on delayed-release penicillin; it is less expensive and requires no hospitalization, which makes it more acceptable to patients. An assessment conducted in January 1999 to evaluate the evolution of the project showed that of the total 274 patients treated, approximately half of them were in the primary stage, which indicates a high incidence of primo-infections. An increase in the cost of treatment was noted due to the different treatment procedures used. Lack of understanding of the criteria on the part of the physician and resistance to adopting a new treatment procedure were among the problems encountered. Thus, an appeal to annul the old ordinance of 1978 regarding syphilis treatment, which requires hospitalization, was made in order to ensure the rapid implementation of the new procedures. Furthermore, DWB is planning to implement a program that will give emphasis to the training of Bulgarian professionals to respect the patients and their rights to confidentiality, reinforce therapeutic services and health education, distribution of condoms, and access to HIV testing and counseling.