Women in the Bronx have been disproportionately affected by HIV, accounting for 27% of New York City's AIDS cases, with African-American and Latina women becoming infected at startling rates. The South Bronx has also suffered from decades of urban decay (a term used to describe physical and social degeneration of parts of a city or town), having not yet recovered from the loss of over half of its housing between 1970-1980. While the literature regarding each of these phenomena illustrates the historical and social context in which they occur, these studies have often ignored the lived experiences of affected women. This paper uses social epidemiology to present and analyze four substance-using womens' experiences and their perceived linkages between urban decay and HIV risk behavior. Through a series of open-ended, structured interviews a qualitative phenomenological study was conducted. Using tenets from the study of social epidemiology, several arguments are made. First, that these women's drug use and high-risk sexual behaviors result from an effort to manage the stresses of their environment. Additionally, these narratives describe adaptive behaviors resulting in "retreatism" and a lack of "connectedness" to their communities. This lack of "connectedness" and meaningful social networks has suppressed the recognition of meaning in these women's lives, provoking a higher level of HIV risk behavior. Finally, communities of women lacking normative guidance, fueled by misconceptions of HIV risk behavior and the externalization of calculated personal risk, have left the women in the South Bronx highly vulnerable to HIV infection. While these women addressed factors of structural violence repeatedly, none perceived their lived experiences with urban decay as influencing their HIV risk behavior. However, using social epidemiology to define the influencing factors named by the women as results of urban decay, it is argued that strong linkages persist between the two phenomena.