From October 1996 to September 1998, the project was 1 of 13 in central and eastern Europe that comprised the International Harm Reduction Development Program. The project is modeled after and received technical support from the Eastern Connecticut Health Outreach project of the University of Connecticut. The Yaroslavl project consists of two interrelated programs: a peer-driven outreach intervention that offers active drug users modest rewards for educating their peers in the community and recruiting them to a storefront for further education; interviews; free HIV, STD, and hepatitis B and C test counseling; and a needle exchange where IDUs can return used syringes for new ones and also receive other harm reduction materials such as condoms. This article reports on the development and implementation of the project and on in-depth interviews with 484 IDUs recruited to the project, 161 first follow-up interviews, 86 second follow-up interviews, and 35 third follow-up interviews. These interviews were based on clients' drug use and sexual risk behaviors, knowledge of HIV and other drug-related harms, and the Yaroslavl drug scene. The article concludes with a discussion of the operational and political obstacles that the Yaroslavl project faces as these factors bear on the future of harm reduction programs in Russia. 1 figure, 6 tables, and 20 references