Because of highly active antiretroviral therapy, people are now aging with HIV. Several stressors associated with aging with HIV may result in increased levels of depression and suicidal ideation. In addition, neurological and cognitive changes that often accompany both aging and HIV must be considered because those aging with HIV are at greater risk of developing such problems. These problems may be reflected in executive functioning deficits and initiation and perseveration difficulties. Adults experiencing such problems may be predisposed to ruminative thoughts that can impair the ability to effectively cope with the stressors associated with aging with HIV. Moreover, other conditions such as posttraumatic stress disorder, chronic drug use, and mitochondrial-damage-related fatigue can predispose these adults to the development of further neurological and cognitive problems. These problems may foster further ruminative thinking and increase the severity of depression and suicidal ideation. Implications for nursing practice, intervention, and research are provided.