For gay men, the demands of the AIDS epidemic are enormous and unrelenting. Regardless of HIV status, all are called on to maintain vigilant safety with sex, to face down a cultural stigma greater even than homophobia, and to somehow find a way to go forward in a world heavy with loss. At long last, current medical breakthroughs offer the hope of changing the face of the epidemic, but the psychological crisis continues. New infections are on the rise among young gay men.

Exhaustion and grief threaten to overwhelm the activism and optimism of earlier years. In a world turned upside down, the challenge of finding meaning is more than an idle philosophical exercise. It is a matter of psychological and perhaps even physical survival.

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Dr. Steven Schwartzberg grounds his insights in his own experiences as a gay man and as a practicing psychotherapist, and in in-depth interviews with nineteen men living with HIV. Ranging in age from twenty-seven to fifty, the men include a construction foreman, a physician, an art historian, a waiter, a librarian, and a licensed massage therapist.

With candor, insight, eagerness, and a remarkable ability to share of themselves, they speak eloquently about how HIV has affected their views of the world, their senses of themselves, and how they live their lives. Interweaving the men's stories with observations from his research and clinical practice, Schwartzberg bears witness to the remarkable transformations some men have accomplished, and the anguish of meaninglessness that weighs others down. He strives to uncover why some view HIV as a catalyst for change or growth, while others see it only as punishment.

And though he passes no judgment on the coping strategies he describes, Schwartzberg does insist on the vital necessity of balancing somber reality with healing, life-sustaining hope. He argues that men who opt for too much illusion and too little reality risk shoddy self-care and inadequate preparation for the future, while those who find no escape from reality may teeter into rage or suicidal despair.