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Armand Learns to Break the Cycle

Armand uses his past experience as an injecting drug user to help other young drug users make the decision NOT to inject

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 – that anyone can 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 admits.

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 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 from a very early age,” he says.  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 heroin to inject instead of smoking hash. I could only afford to share the heroin with them,” he explains. “I didn’t know the risks of HIV. I just knew I had to take the drug, regardless of the fact that I had to use the same syringe with them.” 

Today, Armand is sharing his story with a counselor at STOP AIDS, a non-profit organization funded by UNICEF that offers harm reduction services and advocates for HIV/AIDS testing and prevention:  “I’ve been injecting for ten years now. A few years ago I started to get wounds on my feet because I couldn’t find any veins. Then they went black,” he explains.  “People were saying I would have to cut my feet off.”

Several months ago, Armand met a STOP AIDS outreach worker through a mutual friend. The outreach worker was a fellow heroin user, and offered to help Armand find medical help for his infected legs. “STOP AIDS helped heal my legs. They also explained the risks of sharing needles – the chance of contracting HIV.”  “We’ve been working with drug users for the past three years,” explains Dritan Kamani, Medical Coordinator for STOP AIDS.  “Sharing needles is very common among Tirana’s heroin users.  Through our syringe exchange service, we emphasize the necessity of safe injection to reduce the risk of contracting HIV. 

Because of his first hand knowledge of the problems injecting causes, after his feet were healed Armand became one of the leading participants in Break the Cycle, a proactive communication approach with counselors and drug users that aims to prevent young people from beginning to inject. Many people first sniff heroin, or smoke it on a piece of foil (“chasing the dragon.”)

Armand knows that young people who are using drugs but who are not yet injecting heroin are particularly susceptible to falling into the cycle of injection. Young drug users often approach injectors like Armand to initiate them.  “I see myself in some of the younger people. I know what path they are walking down,” he says.  “Now I know not to inject around people who don’t inject. I don’t encourage young people to try it. I know that once you start with the first hit (dose,) you won’t finish for a long time.”
Armand says that his most fulfilling outreach work involves reaching out to fellow drug injectors. Most days, Armand and fellow outreach worker, Kamani 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 problems with drugs 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 5,000 Lek in your pocket and have no choice but to share a needle,” he says. “But it’s important that people know the risks.”

Armand also passes out clean needles and information leaflets at the hot spots. “Armand has a real talent for this,” says Kamani. “I can give drug users lots of information and try to convince them to stop. But when Armand talks to a drug user, he is able to refer to their shared experiences as drug users and that helps them relate in a different way.” “I feel really committed to engaging with other drug users,” says Armand. 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, Kamani and Armand have both noticed significant changes in attitudes towards injection and HIV among drug users. “I am impressed with how quickly this message has spread. I know people now who are afraid of sharing needles,” Armand explains. “It’s really important that we reach out to both non-injectors and injectors,” Kamani stresses. “By preventing young heroin 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 change among fellow drug users has helped him realize a new sense of self worth. “I see great value in Break the Cycle,” Armand says.  “It has changed the way I think and act. I see it changing others, too.”

by Jennifer Carpenter





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