For individuals living with HIV, AIDS presents an existential as well as medical crisis. HIV-positive gay men (N = 19) participated in intensive clinical interviews to discern how, if at all, they ascribed meaning to AIDS and their HIV infection. The study used phenomenological research methodology (Polkinghorne, 1989) and was informed by the theoretical perspectives of assumptive world theory (Janoff-Bulman, 1992) and humanist–existential psychology (e.g., Frankl, 1959; Lifton, 1980). Ten specific cognitive “representations” of AIDS and HIV emerged (e.g., HIV as catalyst for personal growth or HIV as punishment). Four patterns typified subjects' attempts to integrate HIV into an overall framework for meaning: shattered meaning, high meaning, defensive meaning, and irrelevant meaning. For some, HIV was a transformative catalyst for positive change. Many subjects had adapted well and were coping effectively with the challenges they faced.