Drug Injectors learn to Break the Cycle
By Jennifer Carpenter
Even in Tirana’s boiling summer heat, Armand keeps his body completely covered. He sweats in outdoor cafes in long-sleeve shirts and heavy jeans. It’s only when he sits, and his pants ride up slightly – can anyone catch a glimpse of his black, blistering legs.
“I have been living on the streets since I was 12 years old. I use almost all of my money for heroin,” he admitted.
Armand, 24, is one of hundreds of heroin injecting drug users in Albania – one of the most at-risk populations for HIV. He became a regular heroin smoker when he was 13 years old, while Armand was living in Tirana with his only relative – his blind grandmother. At the time, most of his friends were injectors, including his first girlfriend.
“Heroin has been a part of my life since a very early age,” he said.
Armand took his first injection at age 14.
“I remember my first hit – I was begging on the train. A group of guys offered me to inject heroin instead of smoking hash. I could only afford to share with them the heroin,” he explained,
“I didn’t know the risks of HIV. I just knew I had to take the drug, despite the fact that I had to share one syringe with them.”
Not all heroin injectors feel forced to share. Erion, 32, has been injecting since his late teens and takes heroin at home – unbeknownst to his wife and one-year-old son. Several years ago he was at his lowest – shooting heroin about fifteen times per day. At that time, Erion was paying other addicts to inject him on his back when he could not reach his veins.
“I was desperate,” Erion admitted.
“I would rinse off used needles I found on the street. I had no idea it was dangerous.”
Bledar, 22, said he has always known how his behavior would affect his personal health. However, he has only recently realized how sharing needles could spread disease.
“Here in Albania, drug users are very young. Young people think this addiction is fleeting – we do not think about HIV.”
Bledar has been using drugs since he was 15 years old, and became a regular heroin injector while serving a prison sentence at age 20. Today, Bledar serves as the “middle man” between sellers and buyers, and is often rewarded with injections.
“There is not much information in Albania about HIV. So we just think for the moment,” Bledar explained.
At this moment, Bledar is meeting with a counselor from STOP AIDS, a non-profit funded by UNICEF that offers harm reduction services and advocates for HIV/AIDS testing and prevention:
“We’ve been working with drug users for the past three years,” explained Dr. Dritan Kamani, Medical Coordinator for STOP AIDS.
“Sharing needles is very common among Tirana’s heroin addicts. Through the exchange of syringes service offered we emphasize the necessity for safe injection in order to reduce the risks for contracting HIV.”
Over the past year, STOP AIDS has partnered with UNICEF to introduce Break the Cycle, a proactive communications approach with counselors and drug users to prevent injection start-up among young people.
“Before I met STOP AIDS, I had no idea how high my chances were to get HIV.” Erion admitted.
Several months ago, Erion met a STOP AIDS outreach worker through a mutual friend. The outreach worker was a fellow heroin user, and invited Erion to join a discussion group about HIV.
“I am the kind of person who likes to express my thoughts. So when [the outreach coordinator] asked me to come to a discussion group, I said yes.”
“It’s group therapy in a way,” Dr. Kamani explained. Every week, STOP AIDS organizes a roundtable discussion for a handful of drug users. The participants decide upon the topics for discussion. Almost always the conversation turns to preventing the spread of disease.
“When I talk I get these feelings out of myself and then I share them with others,” Erion said.
“I’ve seen Erion take great care when telling his story with groups,” Dr. Kamani said,
“He shares his personal history so that it can serve as an example to other people.”
“I think talking can help shed light on a lot of problems. I hope that my life story is helpful to those that listen,” Erion said.
Bledar listened. He made his commitment to STOP AIDS after hearing a similar testimony while incarcerated, from a 67-year-old prisoner and heroin user.
“I saw myself in his shoes if I didn’t stop. Sometimes bad models serve as good lessons,” he said.
Nowadays, Dr. Kamani gives Bledar clean needles and information leaflets to pass out during drug transactions.
“We are lucky that clean syringes are available and accessible,” Erion added,
“But I want to stop. I want to do more.”
Soon after embracing this change for himself, Erion started to encourage others to do the same. Recently, Erion and Armand have started to collaborate with Dr. Kamani and the STOP AIDS staff to identify and connect with other drug users.
Most days, Erion and Armand go to common meeting points for drug users, known as “hot spots,” to explain the risks of HIV and the services available at STOP AIDS.
Armand draws from his history of poverty and drug abuse to encourage others to seek out free, confidential HIV testing and counseling services at STOP AIDS.
“I know what it’s like to have only 500 Lekё in your pocket and have no choice but to share a needle,” he said.
“Armand has a real talent for this,” Dr. Kamani said.
“I can give drug user lots of information and try to convince him to stop. But when Armand talks to drug users, he is able to use their shared experience and that helps them relate in a different way.”
“I feel really committed to engage with other drug users,” Armand said.
Meanwhile, Erion reaches out to his own network of drug users. Last week Erion met with a drug user new to injecting and convinced him to sniff together instead. Erion relies on and passion for discussion to encourage safer behaviors among addicts.
“It’s a great achievement to keep a single person from injecting,” Erion added,
“As a participant in this program, I feel good. I know what to say.”
STOP AIDS has reached more than 500 injecting drug users in the last two years. Dr. Kamani is confident that 20% of them will be active in Break the Cycle – enabling young injectors to help their peers avoid injection. Since this program started, Dr. Kamani, Erion and Armand have noticed significant changes in attitude towards injection and HIV among drug users.
“I am impressed with how quickly this message has spread. I know people now that are afraid of sharing needles,” Armand explained.
“They know the difference between clean and unclean needles. I would never inject without a clean needle now.” Erion said.
“It’s really important that we reach out to both non-injectors and injectors,” Dr. Kamani stressed,
“By preventing young drug users from injecting, and by helping injectors to stop, we are helping to slow the spread of HIV in Albania.”
To Armand, advocating for HIV prevention and behavior changes among fellow drug users has helped him realize a new self worth.
“I see great value in the program services, especially in Break the Cycle,” Armand said,
“It has changed the way I think and act. I see it changing others, too.”
UNICEF has helped fund STOP AIDS since 2008. Find more information on the other pages.