The purpose of this study was to test two combination motivational plus pharmacological interventions for smoking cessation among HIV positive smokers. Participants were 40 adults receiving HIV care who smoked daily reporting interest in smoking reduction. Measures were administered at baseline, 1-month, and 3-month follow-ups. Participants were randomly assigned to self-guided reading plus nicotine patch (n = 18) or motivational interviewing plus nicotine patch (n = 22). Groups did not differ at 3 months on biochemically-verified abstinence. The sample reduced cigarettes per day by half a pack and the percent of smoking days by 41%, and 22% were abstinent at 3-month follow-up. Compliance with the nicotine patch was poor and declined over time, but patch use was unrelated to carbon monoxide level at 3-month follow-up. Smoking cessation interventions for people with HIV can be helpful and should include components that encourage some smoke-free days, increase self-efficacy, and attend to adherence to nicotine replacement treatment. © 2007 Springer Science+Business Media, LLC.