Interviews with workers at just over 12 needle exchange programs in Canada identified three tactics that are critical for the successful launch of a program aimed at reducing the risk of HIV transmission among injection drug users. One tactic is to have the local health department and key health officials take the lead role in sensitizing the larger community on the need for a multi-faceted, interagency program to reduce the risk of HIV infection among injection drug users. A second tactic is to have program developers generate police and media support for the needle exchange, and the third tactic is to have program developers integrate the needle exchange with existing street programs. Among the first tasks in the establishment of a needle exchange program are to sensitize the community about the spread of HIV among injection drug users and the need for a comprehensive prevention program, as well as to integrate the needle exchange program with existing street programs. Other initial tasks are to recruit and educate a staff writer from the local newspaper about the program, establish police support, involve intravenous drug users in the planning and implementation of the program, and use Canadian data to illustrate the effectiveness of needle exchange programs in other communities. Current Canadian needle exchange programs offer the following services: needle exchange, AIDS prevention/education information, hepatitis B vaccine, bleach kits, pre/post HIV-test counseling, condom distribution, HIV testing, treatment referral, Sexually transmitted disease/birth-control information, counseling, TB treatment, and needle disposal education and pick-up service. Methods of providing services are also discussed in this paper, along with staffing and staff training, funding, and evaluation. Appended evaluation summaries of Edmonton's and Montreal's needle exchange programs and a list of the names, addresses, telephone numbers, and fax numbers of Canada's needle exchange programs