Promotion of safer sex practices typically includes education, skills building, and condom distribution. To evaluate the impact of such promotions and describe risk factors for sexually transmitted disease (STD), a retrospective review of 741 sexually active HIV-infected women was conducted. The cohort was African-American (82%), at least 22 years of age (81%), acquired HIV through sex (36%), had a CD4 count above 200/ mm3 (76%), and had a history of substance (alcohol or drug) use (38%). Those with incident STD (14.7%) were more likely to be under 22 years of age, to have a history of substance use, and to have an STD at entry. Traditional methods of promoting safer sex practices should be enhanced by other options such as regular screening, partner treatment, and the use of microbicides and other female-controlled methods.