New York has the largest number of intravenous drug users in the United States. As there is a high prevalence of infection from human immunodeficiency virus (HIV) among this group the city has had to confront issues that will face others in the future.12 Health professionals have had to look at ways of reducing high risk behaviour among intravenous drug users, such as using and sharing dirty syringes and needles, and there is some evidence that addicts are changing their behaviour.34 These changes are insufficient, however, and those most at risk?young intravenous drug users? seem most resistant to change. Only a proportion of drug users are in contact with the treatment services and great efforts have been made to try and reach the rest.5 This is a group to which we in the United Kingdom will need to pay attention. The National Institute on Drug Abuse (part of the United States Department of Health and Human Services) is funding two AIDS demonstration projects.6 In one, multiple outreach or early intervention methods will be used to try to communicate information on AIDS to high risk individuals in five cities. In the other different outreach models will be evaluated to find which work best in reaching different target populations. In New York drug users, ex users, and health professionals have set up the Association for Drug Abuse, Prevention, and Treatment to educate addicts about AIDS, give support to the sick, and try to reduce the spread of HIV by drug users.7 As a result of such efforts more drug users are coming forward for treatment than the services can cope with.5 The methadone programme in New York is oversubscribed and there are waiting lists for treatment. The concern is that if treatment is not available addicts will disappear and the efforts to reduce HIV infection will be undermined. Similar pressures could occur in the United Kingdom. The rehabilitation services in the United States are having to cope with dying patients as AIDS presents in residents in drug rehabilita? tion units and among ex-addict staff members. We will also have to train and support staff to deal with these problems.