The influence of HIV on sexual activity and functioning presents a unique set of issues. HIV transmissibility, partner disclosure, potential vertical transmission and, for some HIV-infected women, problems associated with illicit drug use, may affect sexuality. Few studies have examined HIV-infected women's sexuality and none have studied the relationship between HIV symptoms, HIV illness stage, quality of life, meaning of illness and sexual functioning. This descriptive study examines sexual activity, sexual functioning and safer sex behavior among 101 HIV-seropositive women. Results indicate that (1) the majority of women continue to be sexually active after testing HIV positive, (2) sexual functioning does not change as a result of HIV disease progression, and (3) few women report that HIV itself caused worsening of their sexual functioning. Those women with better mental health, more positive meaning attributed to life with HIV infection, better quality of life, fewer HIV-related symptoms and who never used injection drugs had higher levels of sexual functioning. Greater focus on sexual functioning as an integral part of clinical assessment is needed. Patterns of sexual behavior among HIV-infected women require continued study as we search for more effective means to prevent secondary HIV transmission.