This paper examines the needles and syringes that people who inject drugs (PWID) in Tajikistan use and factors that influence their choices. We conducted six focus groups in Kulob and six in Khorog, Tajikistan, with a total of 100 participants. Focus group topics included the needles and syringes used and factors that influence choice of needles and syringes. Most low dead space syringes are 1-ml insulin syringes with 12 mm 28 g permanently attached needles. Findings suggest that these will not be acceptable to PWID who need larger syringes and longer, thicker needles that are detachable. Low dead space detachable needles appear to be an acceptable option that could overcome barriers to the widespread use of low dead space equipment for reducing HIV and HCV transmission.