Significant advances in HIV treatment has meant that for the majority of patients with HIV, they are able to live a normal lifespan. However, HIV remains a highly stigmatizing disease with the potential to significantly impact on one’s social identity and sense of self. This paper draws on data from a qualitative study of interviews with five gay men, to explore the experiences of shame in relation to living with HIV. The paper adopts a psychoanalytic lens to highlight the mechanisms of splitting that may be involved at both a social and individual level, and the experience of shame among the participants. The paper aims to use this research data to supplement our understanding of what may be occurring ‘on the couch’ with patients who are living with HIV.