Recently, quality of life studies among patients with HIV/AIDS have shown high levels of life satisfaction. Spiritual and religious factors may contribute to these positive outcomes. We interviewed 19 patients with HIV/AIDS in order to understand better the role of religious-spiritual biographies and orientations in quality of life, and found four patterns to describe the ways in which past experiences with religion/spirituality and religious/spiritual meaning-making help to explain how patients are currently coping with HIV/AIDS. We illustrate each of these patterns with a prototypic patient: (1) the Deferring Believer (“God allows things to happen for a reason.”); (2) the Collaborating Believer (“This is where I'm supposed to be.”); (3) the Religious/Spiritual Seeker (“I'm trying to get my life together.”); and (4) the Self-Directing Believer (“What else is new?”). The findings support a previously described theoretical model of meaning-making in response to adversity, and they suggest the value of life course and narrative approaches to understanding religious coping.