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People living with HIV have faced a new situation since the arrival of the antiretroviral treatments. HIV has become a long-term condition, which not only affects physical health, but also causes psychological and social problems because of stigma and discrimination. These challenges present many decisions and dilemmas for people living with HIV, which involve complex emotional and psychological issues. The aim of this study was to examine the psychosocial decision needs of people living with HIV. To undertake the literature review, a search strategy was designed. Sources included databases (Web of Science, Scopus, ProQuest, and PubMed) as well as electronic journals (AIDS and Behavior, AIDS Care, and Social Science and Medicine). The following search terms were used: (HIV) AND (decision making; OR decision need; OR decision) AND (psychosocial; OR psychological; OR social). All languages were included, using articles from 1990 to 2009. The search was conducted from September 2008 to November 2009, and identified 123 articles. After analysis, 46 articles were included for detailed assessment. The results show that people living with HIV face three key decisions: (i) whether or not to disclose their diagnosis to others; (ii) decisions about adherence to treatments; and (iii) decisions about sexual activity and desires about parenthood. Problems associated with these decisions often result in isolation and mental illness such as depression and anxiety, lack of access to social support, and refusal to seek treatment. Despite the importance of HIV and its public health impact, few studies have considered the psychosocial needs of people living with HIV, but the results demonstrated the burden as a consequence of those needs and that greater support would be of benefit to face them in an effective way. Therefore, the results of this review highlight the requirement to develop interventions to support the psychosocial needs of people living with HIV, to accurately reflect the views and needs of the target users.