This study examined the relationship between traumatic experiences and PTSD in HIV-positive adults in Cape Town. The study found that sexual assault and exposure to trauma in a war zone were significantly associated with PTSD. Those exposed to sexual assault had 10 times greater odds of a PTSD diagnosis, while exposure to war zone trauma led to 6.9 times greater odds. Overall, participants reported very high rates of exposure to traumatic events. The study highlights the need to address mental health in HIV care and conceptualize HIV/AIDS healthcare with a biopsychosocial model to address the high burden of trauma and mental illness.