Self-report questionnaires on alcohol, nicotine and other drugs were administered to assess the current prevalence of alcohol, drug and nicotine use in our tertiary HIV service and inform the establishment of effective interventions. Many respondents reported use of alcohol over the preceding month (111 out of 152, 73%), and recent drug use (48 out of 137, 35%) and frequently both. Sessional alcohol consumption was prevalent among drinkers (52 out of 111, 47%), and correlated with both early treatment phase (P=0.009) and non-adherence (P=0.03). Encouraged by a notable proportion of patients expressing interest in clinic-based smoking cessation counselling, we recommend a targeted education strategy to motivate patients in health-seeking behaviours.