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OBJECTIVE: To measure changes in self-reported risk behaviour for HIV infections and HIV seroprevalence among injecting drug user (IDU) clients of an outreach harm-reduction programme in Kathmandu, Nepal. METHODS: The Lifesaving and Lifegiving Society (LALS) of Kathmandu began providing sterile injecting equipment and education to Nepalese IDU in 1991. A sample of these IDU were interviewed and tested for HIV each year from 1991 through 1994. RESULTS: Indicators of unsafe injecting fell, as knowledge of HIV rose more in 1994 for those who had been in touch with LALS for longer. Indicators of unsafe sex did not change. HIV seroprevalence remained low, 1.6% in 1991 and 0% in 1994. CONCLUSION: We conclude that programmes for the prevention of HIV spread among IDU are possible and effective in Asia, and are urgently needed.