We documented HIV-risk behavior and the public health context of AIDS in women living with a severe and persistent mental illness. Sixty-one women were recruited from outpatient clinics and day-treatment programs at a state psychiatric hospital. They completed a survey that included measures of HIV-related risk behavior, the perceived importance of 11 public health and social problems including AIDS, HIV/AIDS-related knowledge, perceived risk, and behavioral intentions. Thirty-eight percent of participants engaged in at least one type of HIV-risk behavior during the 2 months before assessment, 23% reported two or more risk factors, and 16% reported three or more risk factors. Consistent condom use was rare. Participants reporting 1 or more risk factors were more likely than those reporting no risk to report histories of alcohol or drug treatment, sexually transmitted diseases, HIV testing, and more perceived risk of HIV infection. Poverty and unemployment were viewed as more serious problems than HIV infection and AIDS. HIV-prevention interventions that are tailored to the needs and priorities of women with a severe mental illness are urgently needed to prevent further infections.