The association of HIV (AIDS) infection with IV cocaine use and attendance at "shooting galleries" in New York City was well-established in the research by early 1986. In the mid-1980's, the New York City Department of Health instituted a pilot project of needle exchange. In the proposed experiment, 200 addicts awaiting entry to treatment would receive specially marked syringes and an ID card (to insulate them from arrest and prosecution for possession of injecting apparatus) as well as AIDS education and referral to drug treatment programs. A control group would receive AIDS education but no needles. Outcomes would be measured by enrollment and retention in the project, AIDS knowledge and changes in risk behavior, self-report of sharing practices, and the appearance of multiple blood types in the returned syringes. The project was assailed by law enforcement and the city's black leaders. The central thrust of the criticism was that such a program would undermine drug law enforcement and deterrence efforts. Until drug abuse and the spread of AIDS through IV drug use are viewed as serious public health problems, public health approaches to prevention are not likely to receive the political support required for an effective needle exchange program.