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Despite a large number of needle-exchange schemes in the U.K., there are few accounts of how particular agencies attract injecting drug users. This paper describes a busy scheme in London, the take-up of services by clients, and the operating philosophy of the staff. From November 1987 to October 1988 The Exchange saw a mean of 257 clients per month, making an average three visits per client each month. An average of 8,950 needles and syringes were dispensed and 6,918 returned monthly, giving an average return rate of 77%. The Exchange also served as a referral agency to clients; 533 referrals were made, 63.4% of which were to drug and non-medical services, 36.6% to health services, and 9.2% to HIV services. To account for the take-up of services the paper describes The Exchange's open access policy, the staff's communication strategies and their adoption of the philosophy of harm-minimization in relation to injecting drug use. It is argued that these must be seen as integral to needle-exchange if it is to succeed as a comprehensive service.

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