To stem the spread of HIV among intravenous drug users, and between them and their sexual partners and offspring, Vancouver initiated a multifaceted "ways and means" needle exchange program in March of 1989. As of the end of October, over 2,600 users have registered. The needle exchange rate has increased steadily, reaching a peak of 98% in November. Increases have also been noted in the number of regular users, and requests for referral to addition, medical, social and HIV-related services. Outreach services, especially using a van, have expanded program availability. Success in terms of clientele response is accredited primarily to the nonjudgemental, nonintrusive approach. The main problems have been the lack of addiction treatment services, financial and personnel constraints created by the large enrollment, and difficulties with Federal/Provincial funding. Funding for evaluation has been requested.