Louisiana has an estimated 45,000 people who inject drugs, yet few services, such as syringe exchanges, which have been shown to reduce HIV and hepatitis infections. The city’s one public syringe exchange receives no government funding and is open for only two hours a week. Because state criminal law prohibits possession of syringes for non-medical use, the exchange operates under a cloud of legal uncertainty. Volunteers from small “underground” exchanges risk arrest to deliver clean needles to people who need them, sometimes by bicycle.