PIP: Intravenous drug use involving the injection of cocaine, amphetamines, tranquilizers, and opiates for recreational purposes has been reported in more than 80 countries around the world. Up to tens of thousands of users may exist in cities on drug shipment routes and in drug-producing areas, and their numbers are increasing worldwide. The sharing of needles and syringes which have traces of HIV-infected blood can transmit HIV. HIV can even survive for more than 1 week in a closed syringe or needle which has not been cleaned. Hepatitis B and septicemia may also be transmitted, while skin infections may result at the site of injection. Possessing, using, and selling injected drugs is against the law in most places; many countries also outlaw the purchase, sale, and possession of needles and syringes without a prescription. These policies simply increase the price of drugs and make it more difficult for drug users to obtain and use safe, clean injecting equipment. Drug users are therefore often very vulnerable to HIV from sharing needles and syringes, as well as from unprotected sex. It is possible to inject drugs safely, stay relatively healthy, and cause minimal harm to self and others, but drug users must be taught how and provided the necessary means. Harm reduction strategies include face-to-face outreach programs of users or ex-users; access to sterile equipment, cleaning materials, and information about safer drug use and safer sex; counseling, support groups, health care, and methadone treatment and maintenance programs; care and support for users, partners, and children living with HIV/AIDS; advocating legalizing the provision and possession of needles and syringes; and supporting users' self-help organizations and involving them in policy development and program design. Research shows that these programs do not increase drug use and may help some individuals to stop using drugs altogether; they are clearly effective in slowing the transmission of HIV. Drug users are demonstrating that, given the means to prevent HIV infection and given access to education and health care, they have the ability to change unsafe injecting practices. Steps to clean used equipment are presented.