Introduction The widespread use of modern ARVs has increased self-management in HIV patients and reduced their contact with HIV services. We explored how patients adjusted to the changing model of care.

Methods We conducted in-depth interviews with 52 adults from two HIV clinics. Participants were purposively sampled to achieve variation in: time since diagnosis and demographic characteristics. Data were examined using thematic analysis.

Results Three-quarters of the sample were virally undetectable, financially stable and generally healthy, although some experienced psychological problems and/or other STIs including HCV. Having adjusted well to the medical regimen they tried to ‘normalise’ their life by a combination of: asserting control over their virus by staying informed about their immunological status and scientific developments; using ‘othering’ methods to assure themselves of the uniqueness of their situation; and keeping their seropositive status hidden from most others. Gay men felt keeping HIV secret was similar to keeping their gayness secret, and being virally undetectable gave some respondents medical legitimacy to not disclose even to sexual partners. By contrast, a quarter of the sample felt the need for frequent contact with the HIV clinic, either because of co-morbidities or other vulnerabilities. Half of this group reported relations with their clinicians suggesting emotional dependency.

Discussion The chronic disease model of HIV management transforms HIV from a collective and political phenomenon into an individualised concern. While patients with complex needs continue to have frequent clinic contact, others isolate and conceal their HIV-positive identity to avoid experiencing stigma in their day-to-day lives.