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Objective: To measure the occurrence and correlates of food insufficiency among HIV-infected crack-cocaine users in Atlanta and Miami, USA., Design: Non-probability cross-sectional sample., Setting: Inner-city hospitals in Atlanta and Miami., Subjects: Two hundred and eighty-seven HIV-infected crack users., Results: One-third (34 %) of respondents experienced food insufficiency within 30 d of interview. Increased odds of food insufficiency was associated with current homelessness (adjusted OR = 3.78, 95 % CI 1.70, 8.41), living alone (adjusted OR = 2.85, 95 % CI 1.36, 5.98), religious service attendance (adjusted OR = 2.34, 95 % CI 1.02, 5.38) and presence of health insurance (adjusted OR = 2.41, 95 % CI 1.06, 5.54). Monthly income greater than $US 600 (adjusted OR = 0.19, 95 % CI 0.06, 0.58) was associated with decreased odds of food insufficiency, and less than weekly crack use was marginally associated with decreased odds of food insufficiency (adjusted OR = 0.39, 95 % CI 0.13, 1.08)., Conclusions: Food insufficiency is very prevalent among HIV-infected urban crack-cocaine users in Atlanta and Miami. Correlates of food insufficiency confirm the social vulnerability of these individuals. Routine assessment for food insecurity should become a routine component of treatment and prevention programmes in at-risk populations.