Eight themes in the HIV/AIDS case management process emerged from a 1998 study of 14 Ryan White Title I-funded case management programs in the New York City tri-county region. For individuals who were struggling with multiple environmental stressors, the diagnosis of HIV or AIDS was merely one of the many pressures that brought them to case management programs. Most came when they were in crisis. Using both chart reviews and focus groups with case managers and supervisors, this article reports that the activities that characterize this region's case management introduce alternative ways of thinking about the HIV/AIDS case management process.