Few studies have directly focused on adherence to highly active antiretroviral medication (HAART) in HIV positive women caring for children. These women may have unique barriers and facilitators to taking medication, and a deeper understanding of their adherence patterns could enhance intervention strategies. A total of 36 HIV positive women who care for children less than 18 years of age were interviewed regarding their patterns and decision around taking HAART. The study group was comprised of 19 Latinas, 10 Euro-Americans, five African Americans and two Cape Verdeans. The mean length of time the women knew they were HIV positive was 11.15 years. Adherence patterns shifted over the course of the women's HIV history. The participants continually discussed medication adherence within the context of events and relationships that either upset or stabilized their adherence. The following themes emerged: (1) shifting adherence patterns; (2) reasons for adherence; (3) reasons for non-adherence; (4) the relationship between distress level and medication adherence; (5) interpersonal relationship as barrier or facilitator of medication adherence; and (6) children as facilitators in adherence. Providers need to be aware of the shifting nature of adherence and its relationship to psychosocial functioning.