Australia's prompt and effective response to HIV among people who inject drugs is recognized internationally. In the early 1980s, there was growing awareness of the evolving threat presented by HIV. Despite erroneous but commonly held assumptions that people who inject drugs generally disregard their health, injecting drug users contributed significantly to Australia's response to HIV. They formed peer-based organizations which advocated for: engaging affected communities in policy development and implementation; funding for peer education; and access to sterile injecting equipment. While government fear of appearing to condone injecting illicit drugs delayed the bi-partisan political support needed to implement programs to provide readily accessible sterile injecting equipment, needles and syringe programs were established relatively quickly. Strong evidence supports the effectiveness, safety, and cost-effectiveness of Australia's early, decisive, and pragmatic public health and human rights-based approach. Without a comprehensive package of harm reduction and peer-based responses, HIV epidemics can develop rapidly among and from people who inject drugs.