What does the future hold? That seems to be the question that links the pieces in this autumn issue.

It wasn't too long ago in some memories that having HIV was a matter of staying alive right now, rather than planning for the future. Even for the newly diagnosed, finding you have HIV can have a paralysing effect on life plans, not least because – in the popular imagination – it often still means illness and early death.

The message is slowly getting through, though, that life expectancy in people on effective HIV treatment is approaching normal. Being positive for HIV can still allow you to be positive about your future.

One of the most fundamental decisions anyone makes about their life is whether and when to have children. Until recently, people with HIV faced daunting barriers to achieving this aim, especially people in different-status relationships, who would be put through – or put themselves through – a sequence of decidedly unsexy procedures – sperm washing, artificial insemination, test-tube fertilisation – in order to have a child but not infect their partner.

In the last two years we've discovered how successfully HIV treatment can prevent transmission; the chances of an HIV-positive person on effective treatment infecting their partner now really are pretty slim.

However, as Joanna Moss discovers in "How are we going to have a baby? I’m positive and you’re not", so-called discordant couples may be getting discordant advice from different specialists about how to reconcile safer sex with conception. Fertility help may still be needed more often for people with HIV, and some couples may want a 'belt and braces' prevention approach that adds in other measures, but the current situation is unsatisfactory and we are eagerly awaiting the publication of new fertility guidelines, which recognise the role of treatment as prevention.

In most of our futures is our old age – an old age many of us thought we would not see. HTU has reported before on research conducted with older people with HIV, which found high levels of isolation, poverty and depression in people who had never planned to get old. How can we fend off such miseries and ensure our autumnal years will be as long and happy as possible? In A healthy – and happy – old age with HIV we talk to a couple of people who are over retirement age, and to their doctor, to get their advice on maintaining health and contentment.

In The generic generation, we discuss not our own future, but that of our treatments. The advent of cheaper, non-patented HIV drugs could be a tremendous opportunity to save a lot of money, to put that money into maintaining healthcare standards in the era of cuts, and even to spare some for research. All that will go to pot if the pressure to save money results in some people staying on regimens that don't really suit them. It's not that generic drugs are worse than branded ones – they are just as good – but that we must never let cost dictate inappropriate treatment.

One way to fend off that slippage of treatment standards is to try and formulate minimum ones. The new BHIVA standards for HIV care, summarised in The bottom line in clinical care, are an attempt to set, in the hardest stone available, a set of minimum treatment standards that should be applicable for the next half-decade, no matter what contortions the NHS goes through and wherever we get our pills. We welcome this document as a contribution to, in an age of uncertainty, securing our future.