HIV-positive MSM may report high-risk behaviors-including drug use and intentional unprotected anal sex-as a means of coping. We recruited a diverse sample of HIV-positive men (n = 66) at gay community events. One third of these men self-identified as barebackers. Barebackers were more likely to report drug use and sex under the influence of drugs (i.e., PnP). Beyond this, those who identified as barebackers also tended to report greater stigma, gay-related stress, self-blame-related coping, and substance abuse coping. Providers must attend to issues of stress and coping to engage men who may not respond to traditional risk reduction efforts.