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HIV-related prevention and intervention efforts for deaf adults with mental illness have been developed in the absence of empirical data regarding the risk behaviors in which this group engages. This study analyzes data provided by 66 deaf adults who received specialized services from a large psychiatric rehabilitation agency. Deafness-related social, linguistic, and behavioral factors are examined in relation to risky sexual behaviors, substance use, and serious mental illness. Risky behavior was significantly elevated among those who use cocaine and alcohol, have a history of sexually transmitted infections, have low levels of social integration and above average linguistic (sign) ability. Proficient sign language ability and engagement in the Deaf community interacted with substance use to increase the risk for HIV. Risk reduction for deaf adults should consider the interaction between mental health symptoms and the social consequences of deafness (e.g., delayed language acquisition). As well, interventions must be straightforward and administered by fluently signing, clinical staff. [ABSTRACT FROM AUTHOR]