The program provides sterile needles in exchange for used needles to help reduce the risk of transmitting the AIDS virus through the reuse of "dirty" needles. It took 3 years for the city to approve a small experimental needle exchange program. There are broad forces in New York City that determine how government will respond to an issue as controversial as a needle exchange program for addicts at risk from AIDS. This study identifies these forces. It analyzes the policy formulation of the needle exchange program from a sociological perspective. The article's thesis is that when dominant political forces perpetuate a status quo and fail to respond to an epidemic, a private advocacy organization representing a competing ideology becomes necessary to compel the government to act. The article applies the concepts of repressed and dominant structural interests (Alford, 1975) before reviewing international needle regulations and efforts to institute New York City's needle exchange program. It proposes that a competing ideology is emerging and discusses implications for New York City's test project. 39 references.