The impact of learning a positive HIV test result on the sexuality of 161 women (47 injection drug users (IDU), 53 non-IDU women of Haitian or African origin (non-IDU-HA), and 61 non-IDU Caucasian women (non-IDU-C) was assessed using closed and open-ended questions. Self-reported CD4+ count correlated with any post-test (p = 0.001) and past month sexual activity (p = 0.007). After learning their HIV status, 110 women (68%) were sexually active, 48 (44%) of these within 1 month. After resuming sexual activity, 84% underwent a sexual adjustment period (median duration 8.5 months). IDU women were more likely to have frequent sex, be anorgasmic, and prefer sex less often. Consistent partner condom use was low in general (19% for IDU, 30% for non-IDU-HA, and 62% for non-IDU-C) and by partner type (new regular partner 58%, same regular partner 36%, casual partner 29%). Sexual satisfaction tended to decline post-test and then increase to higher than pre-test levels. Counselling focused on the safe and satisfying aspects of sex may assist women with HIV infection in sexual decision-making. Facilitating the access of IDU women with HIV infection to medically supervised drug provision and to detoxification and rehabilitation programmes can weaken the link between drug use and sex work.