Injections are one of the most frequently used medical procedures. The World Health Organization (WHO) estimates that 12 billion injections are given annually, 5% of which are administered for immunization and 95% for curative purposes. Unsafe injection practices (especially needle and syringe re-use) are commonplace in low-income country health settings, and place both staff and patients at risk of infection with blood-borne viruses (BBVs). It is estimated that up to 160000 human immunodeficiency virus (HIV), 4.7 million hepatitis C and 16 million hepatitis B infections each year are attributable to these practices. The problem is complex and fueled by a mixture of socio-cultural, economic and structural factors. An appropriate response on the part of international organizations, governments, health administrators, community organizations and health workers, including those who work in the area of HIV/AIDS prevention, has been slow to emerge. This paper reviews the literature relating to unsafe injection practices and the transmission of BBVs in low-income countries in order to raise awareness of the issue and the consequent need to promote injection safety messages amongst both consumers and providers of health care services in these countries. The nature and extent of unsafe injection practices, the burden of blood-borne viral illness attributable to unsafe injection practices, and the factors contributing to these practices are summarized, and possible strategies for promoting injection safety discussed.