We explored 15 HIV-positive substance users’ experiences with health care alongside theperspectives of 14 health professionals. Substance users with HIV reported positive and negative experiences.Positive experiences included equal treatment, receiving social support and extra care, and good continuityof care. Negative experiences included being met with fear and apprehension, excessive or differentialprecautions, unnecessary referrals, outright care refusal, confidentiality breaches, and poor care provision.Health professionals reported limited experience caring for substance users with HIV. Most spoke generallyabout substance users, claiming that they can be difficult clients who are demanding, impatient,unpredictable, and untrustworthy. Also, health professionals indicated that substance users can be shoppersin search of unnecessary prescriptions or avoiders of health care. Efforts to improve interactions shouldencourage positive contact, and should focus on combating attributions of personal responsibility, creatingan awareness of behaviors that are stigmatizing, and improving knowledge of occupational risks for HIV.