Background: Persons living with HIV (PLWH) are disproportionately burdened with methicillin-resistant Staphylococcus aureus (MRSA). Our objective was to evaluate prevalence and risks for MRSA colonization in PLWH. Methods: Adults were recruited from Johns Hopkins University AIDS Service in Baltimore, Maryland. A risk questionnaire and specimen collection from anatomic sites with culture susceptibility and genotyping were completed. Generalized estimating equation modeling identified MRSA colonization risk factors. Results: Of 500 participants,mostwere black (69%), on antiretroviral therapy (ART) (87%),with undetectable viral loads (73.4%). Median CD4 count was 487 cells/mm3 (interquartile range, 316-676.5 cells/mm3). MRSA prevalence was 15.4%, predominantly from the nares (59.7%). Forty percent were nares negative but were colonized elsewhere. Lower odds for colonizationwere associatedwith recent sexual activity (adjusted odds ratio [AOR]¼0.84, P$75,000; AOR ¼ 2.68, P < .001), recent hospitalization (AOR ¼ 1.54, P < .001), incarceration (AOR ¼ 1.55, P