The objective of the paper was to describe awareness of HIV medications and HIV viral load, and to assess the impact of HIV medications (including highly active antiretroviral therapy) and notions of viral load on sexual risk practices. This was an exploratory cross-sectional study of a non-random sample of 395 homosexually active Latino men in New York City. An anonymous self-administered questionnaire was used focusing on perceptions about HIV/AIDS, HIV treatment medications and viral load, risk perceptions, HIV status, and sexual partners and practices in the past 6 months. HIV-positive participants taking HIV medications, those who knew their viral loads, and those who had undetectable viral loads did not report significantly different frequencies of high-risk (receptive or insertive) unprotected anal intercourse (UAI) in comparison to other HIV-positive individuals in the sample. Perceptions about HIV status (assuming same status) and viral load (penetrating partner or letting partner penetrate one) were related to significantly higher high-risk UAI in the past 6 months. HIV prevention strategies for homosexually active Latino men should not only address the basic issue of assuming similar HIV status but also need to examine misconstructions of the transmissibility of HIV as a result of undetectable viral load.