The landscape of HIV has changed from an incurable disease to be more like a chronic disease as the result of advances in medications; the lifespan of People Living with HIV (PLHIV) has also lengthened, HIV defining diseases are delayed, and many of the complications of HIV prevented with adherence to medications. The stigma and discrimination of HIV remain however. PLHIV need to cope with emotional issues of guilt, shame, and self-blame; social issues of rejection, termination of employment, fear and bad social experiences. The paradigm shift from negative regard of PLHIV to that of empathy, which is a deliberate and conscious attitude to relate to PLHIV as fellow travellers in life, to be able to feel with them rather than against them, has therapeutic effects. Empathy has its processes of active listening, responding with appropriately chosen words to describe feelings of the patients, and reflecting the desire to understand more about the patient’s emotions and social turmoil. The benefit of empathy in counseling are the ability to connect with the patient, to build trust from the patient being counseled, and a more objective perspective of being able to see the patient from his/her perspective rather than from the therapist’s perspective. More importantly empathy is a positive response to emotional and social issues experienced by the patient compared to platitudes like “You will be alright; or “don’t worry”, which negate and minimise the opportunity to have a catharsis.