Cervical and plasma samples obtained twice, at 2-week intervals, from 49 human immunodeficiency virus type 1 (HIV-1)-positive women were assayed for HIV-1 RNA. More than 100 copies of HIV-1 RNA were detected in cervical swab supernatants (CSS) from 24 (49%) of 49 women. HIV-1 RNA in CSS was detected in younger women with higher levels of plasma HIV-1 RNA (median, 31,984 vs. 2880 copies/mL; P = .0004), lower CD4 cell counts (median, 190 vs. 390 per mm3; P = .012), and lower CD4 cell percents (median, 16% vs. 25%; P = .03). In multiple logistic regression analysis, only plasma HIV-1 RNA was significantly associated with CSS HIV-1 RNA, with an odds ratio of 4.79/log10 increase in plasma HIV-1 RNA (95% confidence interval, 1.4-16; P = .01). Detection of HIV-1 RNA in cervical secretions is primarily associated with increased plasma HIV-1 RNA.