The four European regions with the highest death rates from diseases of the circulatory system were all in Bulgaria.[1] In the early 2000s, the major natural causes of death were cardiovascular disease (most commonly manifested in strokes), cancer, and respiratory illness. Bulgaria has had a very low incidence rate of human immunodeficiency virus (HIV). Although in 2003 the estimated rate of incidence was less than 0.1 percent of the population, in the early 2000s the number of new case reports increased annually.