His first brush with needle-exchange activism came in 1991, while Jason Farrell was still in residential treatment for heroin addiction. “My employment opportunities were slim,” says the scrappy HIVer and former punk-rocker, 42, who tested positive for HIV in 1990 and for hepatitis C soon after. “I’d burned so many bridges during my addiction.” A year before New York state legalized HIV harm-reduction efforts, Farrell attended ACT UP meetings and discovered an underground syringe swap on Manhattan’s Lower East Side, where he’d grown up. “I used weekend passes from the treatment center to go down there,” he says. He quickly learned that his community needed more than sterile syringes: “Lots of people were infected, guys I’d grown up and shot up with.”

Farrell, now executive director of New York City’s bold harm-reduction organization Positive Health Project (PHP, www.positivehealthproject.org) says he grabbed a bunch of other recovering addicts and “went on a tear.” Pursuing HIV treatment on demand in a nonjudgmental setting (no “junkies need not apply” signs), he won Ryan White and CDC funding to screen and treat active drug users. In 1995, the state Health Department let PHP swap syringes at its current midtown location, which also offers primary health-care services, including HIV and STD testing and gynecological and dental care. Have the city’s druggies bitten? “Hell, yeah,” says Farrell, who describes the waiting room as overflowing with high-risk, hard-to-treat HIVers drawn by PHP’s “one-stop shopping.”

The needle’s tips:

Hook up: The national Harm Reduction Coalition can point you to similar efforts in your city (www.harmreduction.org; East Coast: 212.213.6376; West Coast: 510.444.6969).

Variety show: Find a group with diverse options. In recovery yourself? You may want to avoid triggers—try filing, data entry or phone duty instead of jumping into street work.

Get with the program: Harm reduction means reducing drug risks, not stopping use. “You can’t talk people into treatment—it doesn’t work that way,” Farrell says. “When they’re ready, they’re ready.”