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Because of the moral, legal, and bureaucratic issues that surround the use of illicit drugs and AIDS in the USA, efforts to address the AIDS-prevention needs of IDUs will probably continue to be impeded. Anticipating and resolving structural impediments will be a growing issue for syringe-exchange programmes (SEPs) well into the future. However, adopting public health strategies that are based on the recommendations of the Ottawa Charter, lifting the federal ban on funding SEPs, and deregulating the decriminalizating the distribution and possession of syringes will greatly decrease the transmission of HIV among IDUs. This will, in turn, decrease the spread of HIV to the sexual partners of IDUs (including many individuals who do not know that their sex partner is an IDU) and to their children.