Spirituality and religious practices can buffer people from stressful life circumstances and promote positive biopsychosocial outcomes. The beneficial effects of spirituality and religious practices have been documented in aging and HIV. Unfortunately, little is known about spirituality and religious practices in older adults with HIV. As the number of older adults with HIV increases, with an estimated 91,000 adults over 50 being diagnosed with this disease in the United States, spirituality and religious practices may help HIV-positive people to age successfully. Crisis competence and spiritual trajectories are ways of conceptualizing spiritual development when confronting aging with a life-changing event such as a being diagnosed with HIV. Methodological issues in studying spirituality in adults aging with HIV are identified including defining spirituality and religiosity, heterogeneity of the population, timing of diagnosis, mode of transmission, sexual orientation, religious and cultural stigma, and hardiness. Implications for possible interventions are also posited. © 2007 The Haworth Press, Inc. All rights reserved.