SummaryWhile patterns of health care financing for HIV have received considerable attention in the literature, the financial impact of disease on individuals living with HIV infection has been underexplored, particularly in relation to disease progression. Therefore, we sought to document changes in employment, income, and insurance coverage over time among HIV-negative, HIV-positive, and AIDS-diagnosed gay and bisexual men participating in the Multicenter AIDS Cohort Study (MACS) and to document measures of financial hardship. Persons with AIDS (PWAs) were 2.7 times more likely to lose full-time employment over a 6-month period than seronegative persons (p< 0.05), and loss of employment was strongly associated (p< 0.001) with both loss of private health insurance and loss of income. Twenty-seven percent of PWAs reported having financial difficulty meeting their basic expenses, compared with 10% of seronegatives (p< 0.001), and 15% of PWAs, compared with only 9% of seronegative persons, said that, for financial reasons, they had not sought medical care that they thought they needed (p= 0.028). When 27% of PWAs in a cohort such as this report financial difficulty meeting their basic expenses, it is clear that the response of our public health and social welfare systems has not been adequate. Given that the problems experienced by most persons infected by HIV are considerably more severe than those experienced by MACS participants, the imperative for action is even greater.