This cross-sectional study of 155 sexually active HIV-positive men (48% homosexual, 39% bisexual, 13% heterosexual) sampled at an outpatient clinic in Los Angeles found that negative affective states (depression-dejection, tension-anxiety, confusion-bewilderment, anger arousal, and keeping anger inward) were significantly associated with having engaged in unprotected anal intercourse in the most recent sexual encounter with a male partner. Negative affect was not associated with unprotected vaginal or anal intercourse with most recent female partners. Path analyses suggested that the association of negative affect (composite score) and unsafe sex with male partners was mediated by participants' use of alcohol/drugs in the 3 hours before the sexual encounter. Additionally, the association of depression-dejection and unsafe sex tended to be mediated by attributions of responsibility for protecting sex partners (i.e., more responsibility attributed to partners than to self). The findings support a psychological escape model of sexual risk behavior in seropositive men and demonstrate the need for secondary prevention programs for HIV-positive persons.