A qualitative interview study was conducted to understand the psychological impact of living with HIV among gay men in Finland. Seventeen gay men living with HIV were recruited at HIV support charities in Finland. The data were analyzed using qualitative thematic analysis. The analysis yielded three themes: (1) Self-Stigma and Threatened Self-Esteem; (2) Managing the Assimilation-Accommodation of HIV; and (3) Reconstrual of HIV, Its Meaning and Implications. Self-stigma was pervasive across participants’ accounts and appeared to impede the assimilation-accommodation of HIV in identity. The ability to reconstrue the meanings of HIV and its implications (from something negative to something positive) can facilitate the assimilation-accommodation of HIV in identity, restoring self-esteem, continuity and self-efficacy. The ability to reconstrue HIV may be an important determinant of psychological wellbeing. This should be the focus of behavioral and clinical interventions for enhancing psychological wellbeing in this population.