This article examines associations between self-perceptions of pain and associated pain distress to gender, ethnicity and religion, health care, health status, and emotional distress. Data were collected through interviews collected in participants' homes. Participants were 151 adults with diagnoses of advanced human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). Time since diagnosis, health status, health care, ethnicity, gender, religion, and emotional distress were examined as mediators of pain symptoms, pain distress, and anticipatory pain. Almost all participants (83%) reported AIDS-related pain in the last 3 months. Unexpectedly, pain was negatively associated with time since diagnosis with AIDS. Pain symptoms and pain distress tended to vary by ethnicity, with Latinos expressing more symptoms and pain distress than African Americans. Anticipatory pain varied significantly by gender and religion, with women, Catholics, and Protestants anticipating pain more than men and non-Christians. Anxiety, depression, and general emotional distress were significantly associated with pain symptoms (r = 0.44, 0.33, 0.47) and pain distress (r = 0.34, 0.31, 0.34). Health status and health care were unrelated to pain symptoms, pain distress, or anticipatory pain. Pain is a common problem for people living with HIV/AIDS. Self-reported pain is associated with cultural factors and changes in illness status. Clinicians' attention to patients' emotional distress, depression, and anxiety may assist in interventions for pain management.