The purpose of this study was to assess how body image may be affected by HIV-related weight loss. Qualitative methodology was used: eight gay men with weight loss of at least 10% self-completed a brief, tailor-made questionnaire and then participated singly in semi-structured audiotaped interviews. Questionnaire analysis showed all but one had avoided social activities in the last two months due to self-consciousness over their emaciated appearance; family visits, meeting new people and meeting up again with people after weight loss were most problematic. Interview analysis revealed that in addition to social considerations, bodily comfort and effectiveness were affected, and participants identified weight loss as a clear sign of disease progression. Weight regain was problematic and food had become a difficult issue for most. These results suggest that in gay men, HIV-related weight loss causes significant emotional and physical problems.