There is little available on HIV-positive women's sexual relationships other than within-risk behavior paradigms. Increased life expectancy with the advent of highly active antiretroviral therapies (HAART) may increase the opportunity for women to develop sexual relationships. This study investigates sexual functioning in HIV-positive women and presents the analysis of interviews with 21 seropositive heterosexual women (age range, 22-54). Fourteen (67%) were black African, 6 (29%) white European, and 1 (5%) "other." Thirteen (62%) were currently or had been sexually active since becoming aware of their diagnosis. Dominant themes identified included: (1) difficulties with sexual functioning, in particular lowered libido and enjoyment and reduced intimacy; (2) barriers to forming new relationships: fears of HIV disclosure, fears of infecting partners; (3) coping strategies: included relationship avoidance and having casual partners to avoid disclosure; (4) safer sex: personal dislike of condoms, lack of control, lack of suitable alternatives. Women are experiencing a range of sexual and relationship difficulties that appear to be relatively unchanged despite the advent of HAART. Culturally appropriate, focused psychosexual and couples work should be more readily available for women living with HIV and their partners.