The concept of heroin maintenance is used to refer to a treatment or medical management modality in which heroin is prescribed to addicts. In recent years, heroin maintenance programs have been proposed within a harm-reductionist framework as a response to the emergence of HIV and AIDS among injecting drug users. The rationale for this proposal is that heroin maintenance programs will attract and retain a higher proportion of injecting drug users than existing services, stabilize or reduce drug use, and shift the context of heroin use into a medically supervised framework. Based on the experience with heroin maintenance in the United Kingdom, the author concludes that heroin maintenance may diminish but not eliminate illicit heroin use, drug scene involvement, and HIV-related risk behavior. 12 references