This article explores the ways gay men living with HIV talk about their identities in relationship to ideas concerning essentialism in the broader context of biomedicalisation. Data were collected from 36 HIV-positive gay men between 2001 and 2005 from two studies. All interview material was initially collected and analysed using broadly speaking thematic analysis. Identity-oriented themes were then further explored with a critical lens examining resonances with essentialism. We detail three related themes: 'the intersections of homosexuality, HIV and the biomedical'; 'being HIV: ontological crisis and obstinate essentialism'; and 'identity and treating HIV'. These outline the ways in which both HIV- and gay identities are often interwoven (utilising shared narratives and concepts), embraced and/or resisted. We discuss the concept of essentialism within the wider transformation, or the 'normalisation', of both male homosexuality and HIV and draw attention to the salience of biomedicalisation and concomitant biopower within accounts of gay men living with HIV.