This paper considers psychotherapy and counselling in order to highlight significant anxieties relating to the four existential concepts of Death, Isolation and Meaninglessness. It is the contention of the author that these anxieties are particularly relevant to psychotherapy when HIV is a consideration.The aim is achieved by means of an exploration of some theory, research and experience - in relation to psychotherapy and counselling, HIV and related topics such as terminal illness. The paper is structured using the existential framework suggested by Yalom (1980).