Background: In contrast to the AZT era, currently available antiretroviral therapies are significantly safer and more effective. Consistent adherence is key to viral suppression, and despite dramatic biomedical advancements, many urban people of color living with HIV are not optimally adherent. Previous studies have suggested that HIV medication beliefs are an important facet of adherence. Less is known about how people who are struggling with inconsistent engagement in HIV care may think about and perceive HIV medication. Methods: Twenty-seven semi-structured interviews were conducted with low income Black and Latinx people living with HIV living in the NYC area that were currently, or had been recently, disengaged from outpatient HIV medical care. Findings: This research suggests that socially and economically marginalized people living with HIV, many of whom are long-term survivors who lived through the AZT era, recognize that HIV medication has significantly progressed since early era therapies. In particular, participants recognized that ART is extremely effective in making HIV a chronic, manageable illness. Recommendations: Both clinical practice and public health interventions can benefit from these findings. HIV care providers should specifically speak with patients about their beliefs related to HIV medication in order to discuss any potential concerns or negative experiences. Moreover, public health interventions seeking to improve retention in care should endeavor to explicitly incorporate components that address HIV-medication related beliefs.