In the last 20 years, China has seen a resurgence in drug use, particularly heroin, and with it a growing epidemic of HIV/AIDS. Faced with this dual epidemic, the government has begun testing harm reduction strategies in recent years. These have included methadone maintenance treatment (MMT) programmes, needle-syringe programmes (NSP), outreach, and increasing access to HIV testing. MMT and NSP have moved from the pilot stage to scale-up, with 320 MMT clinics and 93 NSPs now open. Both will number more than 1000 by the end of 2008. There are some good examples of outreach programmes in some areas, however more needs to be done to facilitate greater involvement from non-government organizations. Similarly, HIV testing for drug users is widely available, but novel approaches to increasing its uptake need to be explored. Management of scale-up and reaching China's vast and dispersed drug-using population remain key challenges. The introduction of harm reduction has been a massive turn-around in thinking by the government, particularly law enforcement agencies, and achieving this has required considerable cooperation and understanding between the Ministries of Health, Public Security, and Justice, and the Food and Drug Administration. With their support, rapid scale-up to effectively reach a majority of drug users can be achieved in the coming years.