In the US, African American injection drug users have increased risk for acquiring HIV and for not having long-term survival post AIDS diagnosis. This study examines the cognitive interpretations African American injection drug users make of an HIV-positive test result and the attitudinal and behavioural patterns that accompany those interpretations. Using snowball sampling techniques, street outreach was used to recruit 839 African American injection drug users and their partners for HIV testing and counselling. Subsequently, data were collected for 80 individuals who tested HIV-positive. Individuals who interpreted testing HIV-positive as a 'wake up call' displayed the attitudinal and behavioural patterns of 'being blessed', 'living clean' and 'advocacy'. Those that interpreted the test result as a 'death knell' displayed 'self-destructive', 'pleasure-seeking' and 'vengeance'. Those that interpreted the positive test result as 'just one more problem' displayed 'resignation' and 'minimization'. The period following the diagnosis of HIV provides an opportunity for intervention. A positive HIV status can produce lifestyle changes that either facilitate or militate against a person's health and quality of life. HIV-prevention efforts can be improved by helping individuals living with the virus to interpret and act on their diagnosis in positive ways.