This study sought to identify strategies for living with the challenges of HIV and antiretroviral (ARV) use among new medication users in urban Zambia. Participants (n = 160) were recruited from urban Lusaka, Zambia. Qualitative Data was drawn from monthly ARV treatment education intervention groups addressing HIV and antiretroviral use. Themes included community stigma, nutrition, social support and HIV/ARV knowledge, concerns and beliefs. Strategies for adherence included family, friends, and community organizations that provided emotional and financial support regarding medication, feelings of depression, help with household duties, transportation and companionship at clinic visits and assistance during illness. Social support was the most frequent strategy in coping with ARV use. Challenges included learning to take medications regularly (51%), remembering information about medication (29%), clinic wait times (24%), timing of doses (28%), transportation (23%), food (23%) and lack of social support (23%). Results highlight needed programs to support nutritional supplementation and reduce stigma and the utility of support groups targeting new ARV users to enhance health and encourage sharing of challenges and solutions for consistent ARV use. Strategies for the establishment of health behaviors supporting medication use early in ARV prescription are presented as an important element in long term adherence. (Contains 3 tables.)