To establish population-based estimates of the prevalence of any alcohol consumption and heavy drinking among individuals who tested positive for human immunodeficiency virus (HIV) and to identify the factors associated with alcohol consumption and heavy drinking in this population. Data from the HIV Cost and Services Utilization Study (HCSUS), a national probability survey of HIV-infected adults receiving medical care in the U.S. in early 1996 (N = 2,864: 2,017 men, 847 women), were used to estimate the prevalence of any alcohol consumption and heavy drinking. Logistic regression was used to identify independent influences of sociodemographic, health status, and substance use variables on alcohol consumption and heavy drinking. Approximately 53% of persons in care for HIV reported drinking alcohol in the preceding month and 8% were classified as heavy drinkers. Of those who drank, 15% were heavy drinkers. The odds of heavy drinking were significantly higher among users of cocaine or heroin and significantly lower among the better educated and those with an AIDS-defining illness. Alcohol consumption is common among people in care for HIV, with rates of heavy drinking almost twice those found in the general population. Heavy drinking is especially higher among individuals with lower educational levels and users of cocaine or heroin.