From crowdfunding to government support: How Bulgaria’s only harm reduction center secured public support and government resources

EHRA: Until recently, Bulgaria was seen as a place where harm reduction services had shut down, with the situation quite bleak. Now, it seems that things have changed. Can you tell me more about when and how this happened?

Yuliya Georgieva: You know about the Pink House—the project began in 2019. We started as a low-threshold center for people who use drugs in Sofia. Initially, we provided basic support such as food, clothing, and access to a bathroom. Over time, we identified additional needs, such as a lack of personal documents and disconnection from the social and healthcare systems. These challenges make reintegration into society nearly impossible. In response, we expanded our efforts to address these issues. We developed a program for social inclusion that helps individuals obtain new IDs, access social support, receive social pensions, and secure housing. We also began covering medical expenses for those without health insurance and assisting those with some social support to maintain their health insurance, which is a “must” for accessing healthcare in Bulgaria. For the first two years, we covered all expenses through crowdfunding and made efforts to secure government funding, but it didn’t work out In the following two years, we managed to fund our work through several projects, primarily related to addressing the consequences of the COVID-19 pandemic. Then, in 2023, we had a breakthrough. The government, through the Sofia municipality, provided funding, and we signed a five-year contract for all Pink House activities. Additionally, we received a grant from an international donor at the same time. With this support, we started expanding services—outreach, needle exchange, and IBBS (Integrated Biological and Behavioral Surveillance) for our clients. Things took off from there, and now we’re opening a branch in Plovdiv, which has a large Roma community. The new facility is expected to be fully operational by the end of the year. We choose Plovdiv not only because it is the second-largest city in Bulgaria but also because there is a well-trained team from another foundation that has been working in the area for years.

EHRA: What services are now supported by the government, and what does the other grant cover?

Yuliya Georgieva: The Municipality of Sofia supports all activities related to social services we offer. This includes meeting basic needs such as clothing, shoes, and food; offering social support for our clients; social and healthcare case management; and covering some health expenses, such as medical examinations and medications. Additionally, the municipality funds all team salaries, including those for the psychiatrist, psychologists, nurse and social workers, as well as the rent and overhead costs of the facility.
The other donor covers everything related to outreach, including the supply of consumables such as needles and syringes, smoking kits; IBBS, testing and the costs medical staff. We’re also working on securing long-term government funding for these kinds of activities. We applied and were chosen for a public tender, but the funding available is very limited and the process complicated. However, we’re now in a serious collaboration with the Ministry of Health, which is something we couldn't achieve for years.

EHRA: Did something change within the Ministry?

Yuliya Georgieva: People changed. We’re in a serious political crisis here, with upcoming elections—eight in four years—so stability is rare. Currently, though, we have allies. The municipality’s deputy mayor supports us, and we’re planning many new initiatives with them.

The only challenge the Municipality has struggled to address is securing a permanent location for our facility. In May 2024, we had to leave the premises where we had worked for five years. This has become a serious problem, as we have not yet been able to find a suitable alternative. Currently, we are operating out of a very small municipal space that does not meet our needs.

The mayor of the Serdica region in Sofia made a significant effort to help, securing a plot of land where we could place a movable house. In response, we launched our largest crowdfunding campaign to date and raised €52,000 in just one week to purchase the house.

Unfortunately, this progress coincided with consecutive elections, which allowed a far-right party to gain visibility. They organized protests against us, and as a result, the commissions of the Municipality parliament decided to reject our project for the house at the proposed location. We are now in the process of securing another site for the house.

EHRA: Are you the only organization providing harm reduction services in Bulgaria?

Yuliya Georgieva: Yes, we are.

EHRA: Does the state funding cover needle exchange services?

Yuliya Georgieva: No, the funding is so limited that it barely covers partial staff costs, not supplies like needles. Thanks to another donor, we’re currently able to run a needle exchange, but it’s unclear what will happen when that funding ends. The current HIV Strategy also ends in 2025, and we’re hopeful there will be political will to extend it. Just recently, I met with a Ministry of Health official who seemed very supportive, which is promising. The numbers are stark—we’ve tested over 900 people this year, and 82 are HIV positive, with 60% also having Hepatitis C.

EHRA: So, the government funding really only covers staffing?

Yuliya Georgieva: Yes, it’s enough to partially cover staff costs but not actual services or supplies. However, considering that seven years ago we had nothing, it’s still progress. We started with crowdfunding, and I was the only staff member. Now, we have 13 people in our team. The real challenge will come when another donor funding ends. The goal is to secure a sustainable funding mechanism for harm reduction across Bulgaria.

EHRA: What about the mobile outreach vans?

Yuliya Georgieva: Our mobile outreach vans are only active in Sofia. In Plovdiv, harm reduction was previously provided by another organization that closed and donated their van to Ukrainian refugees. Now, we’re actually borrowing that van for outreach! It’s old and in poor condition, but it’s something. The Ministry of Health also has mobile units that we could use, but they must be staffed by medical personnel from the regional health inspectorates, who aren’t familiar with our community or practices. Still, this problem will be minimalized when we open the Pink House – Plovdiv in the end of the year. We have a contract with the Municipality of Plovdiv and are repairing the building now.

EHRA: Can you describe what services the Pink House currently offers?

Yuliya Georgieva: The Pink House functions as a day center where people can come and spend time. But it’s small, without a bathroom, which is challenging, especially with winter coming. We’re hoping to find a bigger place, but locations that meet municipal requirements are limited. Ideally, we’d have our own mobile or movable building so that if there’s a change in political support, we can relocate.

EHRA: It sounds like the public is also more supportive now. Has that made a difference politically?

Yuliya Georgieva: Absolutely. In the beginning, no one talked about harm reduction, and I was seen as a lone voice. But now, the public has become much more supportive, and that’s influenced political action. Harm reduction isn’t seen as a "junkie" issue anymore but as an important social cause. I’ve even become an advisor to a few politicians who are using drug policy messages in their campaigns. So, the public’s support has pushed this issue into the political spotlight, which has been a huge change.

EHRA: It’s impressive that you’ve also gained support from the Ministry of Social Affairs. What has that experience been like?

Yuliya Georgieva: That’s been a revelation. The Agency for Social Services Efficiency understand the problem better than health officials because harm reduction involves social issues that are more visible to people than health risks. The Social Ministry is much more open to support our work. Looking back, I think focusing solely on the Ministry of Health was a mistake. Social services deal with people’s daily lives, so they understand the urgency. This collaboration has even set a precedent for government funding of harm reduction in Bulgaria.