The study of identity based on the presence of disease has traditionally focused on landmark events, such as diagnosis or the introduction of treatment options. These events have been shown to significantly alter so-called “illness identities.” The project was undertaken in Atlanta, GA, which has a relatively high rate of HIV infection and a large number of HIV-related services and support mechanisms. This study contextualizes illness identities within a larger socio-political and economic paradigm, recognizing that individuals use multiple identities to inform their interactions and decisions, specifically those regarding the beginning and continuation of antiretroviral (ARV) treatment. In addition, structural barriers which limit one’s access to ARV treatment are considered within a context of social and economic marginalization and inequitable power relationships within a post-industrial Western society.