This study was designed to investigate suicidal ideation and attempts, thoughts about living and dying, and the maintenance, diminution and loss of hope in a sample of long-term AIDS survivors. The study sample consisted of 53 gay men enrolled as clients at Gay Mens Health Crisis in New York City who had had an AIDS-defining opportunistic infection at least 3 years prior to study entry. Despite the experience of protracted biological stress associated with life-threatening illness and the psychological stress of living with AIDS, we found low rates of current syndromal mood disorders (6%) or psychiatric distress. While thoughts about death and wishes to die were reported by a significant portion of men, they were context-specific, occurring almost exclusively during serious illness, often accompanied by severe pain or at times of bereavement. Only two men had made a suicide attempt after being diagnosed with AIDS and both had a history of prior (pre-AIDS) suicide attempts. While anger was a prominent affect, hopelessness was not. Overall, we found a high level of positive psychological health independent of HIV illness stage or degree of illness-induced physical limitation.