Since the development of a new class of HIV drugs in the mid-1990s, many people who had gone into "HIV retirement," as their nonworking status is often referred to, are in limbo. They once assumed they would die an early death, but the drug regimens have allowed them to survive longer than they ever thought possible. This means that insurance companies that once approved AIDS-related disability claims, expecting that the payments would end in a year or two, may have to support patients for decades.

Winthrop Cashdollar, a disability expert at the Health Insurance Association of America, a trade group of Washington, acknowledged that insurers had to change their policies about reviewing HIV-related claims to correspond to the new medical reality. "Until fairly recently, AIDS was an imminent death sentence, so claims tended to be approved quickly and paid," Cashdollar said. "And perhaps there was no review to speak of. Now there has to be, because HIV/AIDS has become manageable, like some other diagnoses."

The trade association does not keep statistics on how many HIV-positive people are receiving long-term disability. But Per Larson, a New York financial analyst for HIV-positive people, estimated that the figure was easily in the tens of thousands.

Doctors who treat people with HIV/AIDS are frequently caught in the middle. Dr. Stephen Becker, a San Francisco primary care physician, said the time he spends defending disability claims has increased markedly in the last three years.

And many disability insurers he has dealt with, he said, seemed to resist the notion that patients who are HIV-positive can remain disabled even though their lab-test results may improve. One problem is that some symptoms caused by HIV and the drugs used to treat it can be harder to measure objectively. And the disability companies, he added, scour medical records for signs that the person can work again. "If the person doesn't note a symptom in the charts every time, the insurers construe that absence as a sign that the person is better," Becker said. "I think they're playing hardball."

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