Objectives To examine the living strategies used by older men living with HIV to deal with the episodic nature of disability and associated uncertainty, over time.

Design Qualitative longitudinal study in which men living with HIV were interviewed on four occasions over 20 months.

Setting Men were recruited from HIV community organisations in Canada.

Participants 14 men with a median age of 57.5 years and median time since diagnosis of 21.5 years.

Results Five themes depict the living strategies used to deal with the episodic nature of disability and uncertainty over time. Actively engaging in problem-solving by prioritising and modifying activities and avoiding stress, advocating for support, being positive and future oriented, engaging in healthy pursuits and providing social support to others helped men to mitigate their disability. By following participants over time, we were able to gather insights into triggers of episodes of disability, and perceptions of the success of implementing their living strategies and avoiding uncertainty.

Conclusions Participants used living strategies to deal with uncertainty and mitigate episodes of disability over time. This study supports the importance of programmes that promote self-management for older men living with HIV through helping them identify triggers of disability, set realistic goals and problem-solve. These may help build self-efficacy, increase sense of control, and decrease feelings of uncertainty and episodes of disability.