The role of substance abuse in the transmission of HIV and AIDS is clear, and the current trend in the pandemic shows that a disproportionate number of minorities in inner cities are affected or are at risk for contracting HIV. The recommendations and guidelines in this TIP support the creation of a comprehensive, integrated system of care for HIV-infected substance abusers. Challenges facing this approach include bringing together disciplines that traditionally work independently. Providers should identify other programs and agencies with which to network in order to provide care for their clients. Providers must work to develop culturally competent systems of care. This involves making services accessible to and highly usable by the target risk populations. Effective systems will recognize the importance of culture, cross-cultural relationships, cultural differences, and the ability to meet culturally unique needs. Counselors working with HIV-infected substance abusers should also be aware of the variety of both HIV- and substance-induced psychiatric symptoms. It is important to recognize the number of sources from which these symptoms can stem. Treatment programs that do not have the resources to adequately assess and treat mental illness should be closely linked to mental health services to which clients can be referred. Ethical and legal issues are also discussed, as well as funding and policy considerations. (Contains 11 appendixes, approximately 500 resources, and 49 figures.) (JDM)