This thesis explores the public health practice of a needle exchange program from the perspective of outreach workers in a Southern U.S. city. I explore how outreach workers understand the harm reduction ideology that underlies needle exchange practices as well as intrinsic and extrinsic motivations for participating in the work. I also consider how the needle exchange impacts outreach workers’ lives and its social importance as a therapeutic community. I argue that the needle exchange represents an important social space that functions as a therapeutic community for outreach workers where the harm reduction ideology is applied to both clients and outreach workers alike.