Theorists posit that personal decisions to disclose being HIV positive are made based on the perceived consequences of that disclosure. This study examines the perceived costs and benefits of self-disclosure among African American injection drug users (IDUs). A total of 80 African American IDUs were interviewed in-depth subsequent to testing HIV positive. Participants reported that interpersonal costs of self-disclosure included stigma, loss of sexual/romantic partners, emotional harming of family/friends, shattering of privacy, physical isolation, blame, and loss of income. The benefits of disclosure included social support, emotional catharsis, and income. Four factors that help to tip the scales in either direction were identified. Study findings have implications for the delivery of counseling, testing, and partner notification services to African American IDUs living with HIV.