In the 1990's an explosive outbreak of HIV was identified among people using injection drugs in Vancouver. This occurred in a relatively small area of the city that had become notorious for its open drug scene, crime, homelessness, and poverty. Although a needle exchange was operational at the time, the introduction of cheap powder cocaine over-whelmed the supply of clean needles and syringes. In addition, people were poorly informed about the risks of HIV transmission and health and social services were grossly inadequate. By the end of the 1990's, it was estimated that 25% were HIV positive and over 90% were Hepatitis C positive among the estimated 6,000 people using injection drugs in this neighborhood. In response to this public health disaster, a number of community groups expanded harm reduction programs, however intense law enforcement continued to be the major response to illicit drug use. Although Vancouver has adopted a number of innovative and successful programs, including a supervised injection site, the debate around harm reduction has intensified in Canada. Lost in the debate are the men and women most impacted by drug addiction and poverty who continue to suffer and die from largely preventable bacterial infections, HIV, Hepatitis and overdoses.