Medication adherence among elderly HIV/AIDS patients in urban settings is a critical issue affecting preventive healthcare outcomes. Qualitative interviews were conducted with a purposive sample of elderly patients (n=20) recruited from public health clinics across three major cities. Data collection involved semi-structured interviews lasting up to one hour each. Themes emerged regarding the challenges faced by participants, including financial constraints and side effects, which significantly impacted their adherence behaviors. The findings suggest that understanding these contextual factors is essential for developing effective strategies to improve medication adherence among this vulnerable population. Public health initiatives should incorporate support services such as financial assistance programmes and counseling on managing side effects to enhance adherence rates. elderly HIV/AIDS, urban settings, medication adherence, qualitative study