Question

I have a list view control that users can add items to but I need to be able to tell what item they have selected.

Answer 1

Use the SelectedIndices property. The SelectedItems property will return you the actual objects that are in the list (which you may have to do anyways).

EDIT: Sample (sorry, my VB may be rusty):

If myListView.SelectedIndices.Count > 0 Then
    int selectedIndex = myListView.SelectedIndices[0];
    ' Do other stuff
End If