This study set out to ascertain what proportion of HIV-positive heterosexual men cared for at a central London teaching hospital HIV medical unit, were referred to the Psychological Medicine Unit, and to compare those HIV-positive male heterosexual patients with age and sex matched HIV-positive gay male controls. Hospital and Psychological Medicine Unit databases were interrogated to identify relevant patients seen during the period between February 1992 and December 2002. Furthermore, 50 heterosexual patients, who had been referred to the Psychological Medicine Unit, were matched for age and date of referral, with one gay male HIV-positive control patient. Demographic and illness data was gathered for the subjects and controls. Data was collected on 50 subjects in each group. The main findings of the study were: (1) that heterosexual men with HIV are almost three times less likely to be referred for specialist mental health care than HIV-positive gay men; (2) that heterosexual men with HIV disease, who were referred to the Psychological Medicine Unit, were less likely to be from a white ethnic background compared to gay men; (3) were less likely to be given a diagnosis of a depressive illness; but (4) were more likely to have a substance misuse diagnosis. Gay male patients who are HIV-positive are more likely to experience difficulties with sexual dysfunction, and receive a formal psychiatric diagnosis. The implications of the findings are discussed.