Prince George's County, MD has the second highest incidence of HIV in both the Washington, D.C. metropolitan region and the state of Maryland. Approximately 14% of the living cases of HIV/AIDS in Prince George's County in 2009 were attributable to injection drug use. In the 1990's, Prince George's County was one of only two jurisdictions in the state of Maryland to be granted an exemption to the state's drug paraphernalia law to operate a needle exchange program, a harm reduction intervention shown to be effective in lowering incidence rates of HIV in injection drug user populations. However, Prince George's County has yet to implement a needle exchange program to reduce the spread of HIV among injection drug users. This study examined the perceptions of key community stakeholders on what possible barriers and facilitators to the implementation of a needle exchange program exist in Prince George's County. Qualitative, in-depth interviews were conducted with stakeholders from the community sectors of elected officials, law enforcement, public health professionals, drug treatment counselors, neighborhood associations, and religious institutions from two legislative districts within the county. Themes and sub-themes emerged naturally using the Grounded Theory Model of qualitative data analysis. The themes that emerged in connection to barriers and facilitators to needle exchange program implementation included the image of Prince George's County, stigma, needle exchange as a political issue, benefits and harms of needle exchange programs, funding, injection drug use as a declining problem in the county, a need to raise awareness about HIV transmission in injection drug users, and differences between inner-beltway and outer-beltway areas in Prince George's County. Based on analysis of these themes, the barriers and facilitators to needle exchange program implementation in Prince George's County were identified and described, the feasibility of implementation was assessed, and recommendations were developed for local policy makers to aid in the implementation. Overall, barriers outweighed facilitators by more than 3 to 1, and the assessment concluded that implementation of a needle exchange program is unlikely at this time. However, this research sheds light on the history of needle exchange for HIV prevention in Prince George's County, and can be used to inform future research on harm reduction efforts.