Providers of medical care to persons with human immunodeficiency virus (HIV) infection tend first to see things in mechanical terms. The epidemiology of the acquired immunodeficiency syndrome (AIDS), the pathophysiology of illness, and the possibilities of intervention are essential dimensions of our response to the epidemic, but they are not enough. In this new book, Dennis Shelby describes the experiences of gay men who have tested positive for HIV antibodies. First, he describes his methods of data acquisition and analysis; then he introduces his results in a way that parallels the biological evolution of HIV infection. The individual experiences of testing positive for HIV are described in seven different stages. The HIV epidemic is unique, and Shelby describes the stress, coping, and adaptation that pertain to HIV seropositivity. The experiences related include a response to the physical reality of being HIV positive, but I was impressed that this was often secondary to concerns about how the infected person is regarded by others. Society's neglect and the cruelty of victim-blaming are well-known aspects of the HIV epidemic, but Shelby goes beyond this. He states: "HIV infection does not occur in a vacuum; we all live and are sustained by a matrix of human relationships [including] partners, friends, family members, physicians, other medical personnel, support group members, and the therapist." One of the insights I gained from reading this book is that support can occasionally be found for the HIV-infected person in this matrix of human relationships, support that the infected person did not believe or expect would exist. One touching example is that of a young niece who enjoyed the company of her gay uncle and was concerned about his welfare.

Although the book is largely descriptive, the chapter on clinical intervention provides an analysis of the experiences with references to self-psychology. The bibliography is limited but sufficient to provide a formal framework for the results of this study. The insights in this book will be valuable both to people with HIV and to those who help them.