Background: Previous research has found disproportionately high rates of intimate partner violence (IPV) among low income, urban women seeking emergency medical care. Accumulating research has also found that IPV co-occurs with drug use and sexual HIV risk behavior among different populations of women. However, the co-occurrence of these problems remains underresearched among women who receive emergency medical care, which is often the principal source of health care for low-income women at high risk of IPV, HIV and drug use. This NIMH-funded study examined the prevalence of physical and sexual IPV and its association with drug use and sexual HIV risk behavior among women receiving care from an emergency department (ED) serving low income, minority neighborhoods in New York City. Method: A random sample of 799 adult female patients was recruited from an ED to participate in this study. A random time block procedure was used to select 230 six-hour time blocks from a pool of all shifts in the ED between August 2002 and April 2003. These time blocks represented all shifts in a 24-hour period across seven days of the week. Trained, bilingual Latina and African American female interviewers conducted brief face-to face interviews with participants, which covered socio-demographics, drug use, sexual risk behavior and IPV as measured by the Revised Conflict Tactics Scales. Propensity score matching and multiple logistic regression (MLR) were employed to analyze the data. The mean age of the women was 37 years; the majority were Latina (58%) and African-American (35%). Results: Of the total sample, 50% experienced lifetime physical, injurious and/or sexual IPV, 12% experienced such IPV in the past six months and 3% were at the ED because of injuries from IPV. After controlling and matching for background variables, MLR results indicate that recent physical IPV was associated with women's heavy drinking [Odds Ratio (OR)= 3.7, Confidence Interval (CI)= 1.8-7.9], marijuana use [OR= 2.5 , CI= 1.1-5.4] and illicit drug use [OR= 2.6, CI= 1.2-5.5]. Women who reported recent IPV were also more likely to indicate that they recently had sex with a risky partner [OR= 6.4, CI= 1.4-28.8], less likely to report being monogamous in the past year [OR= .2, CI= .1-.4] and less likely to report testing HIV negative [OR= .3, CI= .1-1.0] at an almost significant level. Conclusions: The high prevalence of IPV and its association with substance use and HIV risk among this random sample of women underscore the need for routine screening for IPV in EDs. Because the ED is often the first system of care that impoverished, abused women may access, it may be an ideal setting to launch a brief intervention to address IPV. Such an intervention may include: routine screening for IPV, an assessment of co-occurring problems, safety planning and enhanced provision of targeted, culturally congruent referrals to address IPV and other identified co-occurring problems. Longitudinal research is needed to tease out causal relationships and identify key mechanisms linking IPV with drug use and HIV risk, which would further inform future social work interventions.