Ukraine continues to face one of the worst HIV epidemics in Europe. To date, prevention efforts there have largely consisted of information dissemination and needle/syringe exchange and distribution. In an effort to introduce new, culturally relevant and effective prevention strategies into Ukraine, a team of medical anthropologists and sociologists from the U.S. and Ukraine worked with local HIV activists in Ukraine to create and pilot novel, bottom-up interventions for drug users based on U.S. behavior change theories.