The primary aim of this article is to describe modifications made to Dialectical Behavior Therapy (DBT) for a predominantly ethnic minority population of persons living with HIV/AIDS with substance-use diagnoses and borderline personality disorder (BPD) or three features of BPD plus suicidality (i.e., the triply diagnosed). Despite the myriad psychosocial needs of the triply diagnosed, there remains a dearth of treatments available that can adequately address the challenges presented by these individuals' dual diagnostic and HIV status. The key modifications we developed and describe in this article are (a) modification of Stage One, Target 2, behaviors to include HIV treatment adherence targets, (b) new and modified standard skills that address needs of the triply diagnosed client including methadone clinic-relevant skills and adherence skills; (c) expansion of the role of the therapist consultation group to include the DBT Therapist Path to HIV/AIDS Competence and HIV-related psychotherapy themes; and (d) use of a Consumer Advisory Board to provide consultation and feedback on treatment adaptations. A case study is presented that illustrates these modifications.