Some programs operate under the auspices of local health authorities using public funds, while others use private and charity funds but operate with the tacit consent of local authorities. Still others operate without official sanction and outside the law; for example, the National AIDS Brigade and Act Up distribute needles at the rate of 200,000 -- 300,000 per year and are getting arrested for doing so. Some local prosecutors ignore needle exchange programs, while others arrest and drop the charges. Although the United States does not have a national needle exchange policy, the involvement of mainstream AIDS organizations in supporting needle exchange activities has taken these activities a step closer to formal institution and legitimization. Various needle exchange programs across the country are described. Obstacles to extending needle exchange programs and integrating them with other AIDS prevention activities are discussed. A table identifies needle and syringe exchange programs operating in Washington, Connecticut, Hawaii, Colorado, California, Oregon, and New York.