The analysis emphasized that substance abuse, violence, and AIDS are not best understood as three separate and simultaneous problems in the inner city. Instead, they form a complex of mutually reinforcing components of a syndemical health crisis that exists in a particular socioeconomic context and that threatens the lives of the Hispanic adolescents and adults being studied and assisted through research and intervention projects in Hartford. The Puerto Rican community of Hartford is characterized by high rates of poverty, low educational levels, unemployment, alcohol-related problems, and family effects of problem drinking. Puerto Rican youth experience high dropout rates and high levels of identity confusion. Many join gangs; street gangs now control Hartford's drug trade. Gang membership also significantly increases a youth's exposure to violence and risk for exposure to AIDS. Programs to address the problems experienced by these and other urban youth need a holistic perspective that recognizes the significant linkages between various health and social conditions. Table, note, and 87 references