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Users of intravenous heroin, cocaine, and amphetamines risk the transmission of human immunodeficiency virus (HIV) through the sharing of contaminated injection equipment. Although most users are aware of this risk, the scarcity of sterile needles and syringes, combined with various social and cultural factors, fosters dangerous sharing practices. This paper examines the legal and political contexts of proposals to ease access to sterile needles and injection equipment. The author seeks an explanation for the continued reluctance to institute such programs in the United States, while similar programs have been instituted in other countries where intravenous drug use has also contributed to the spread of HIV infection and AIDS.