Over the past five years, the proportion of AIDS cases among gay and bisexual men in New York City has fallen as the proportion of AIDS cases has risen among IV drug abusers, the major channel of HIV infection to children and heterosexuals in New York City. By 1991, there will be over 40,000 cumulative AIDS cases in New York City, with close to 30,000 deaths. Controlling the spread of HIV infection among drug addicts, children, and heterosexuals requires education, outreach, and exploration of strategies such as increasing the legal availability of sterile needles and syringes. For at least the next several years, massive programs of public health education and voluntary, confidential risk-reduction counseling and HIV antibody testing will remain our critical weapons for reducing the spread of HIV infection among people engaged in high-risk behavior as well as among the general public.