OBJECTIVE: To compare risk factors for injecting equipment sharing among injecting drug users (IDUs) in Togliatti City, Russia. DESIGN: Unlinked, anonymous, cross-sectional community-recruited survey with oral fluid sample collection. METHODS: Between September and October 2001, 426 IDUs completed an interviewer-administered questionnaire and oral fluid samples were tested for HIV. Univariate and multivariate analyses compared potential risk factors for injecting equipment sharing. RESULTS: More than half (56% [234/418]) of the sample were positive for antibodies to HIV. A third (36%) had injected with used needles and syringes in the last 4 weeks. IDUs who reported syringe exchanges or outreach workers as their main sources of new needles and syringes in the last 4 weeks had 0.3 times the odds of sharing compared with those obtaining them from a pharmacy or shop, whereas those whose main source was buying them from the streets or obtaining them from friends, sexual partners, or other drug users had 12 times the odds of receptive needle and syringe sharing. IDUs who reported being last arrested or detained by the police for a drug-related offense had higher odds of sharing. CONCLUSIONS: Findings highlight the delicate balance in HIV prevention between potentially competing strategies of law enforcement and syringe distribution.