Methods: We conducted six focus group discussions (FGDs) with youth living with HIV (ages 18-24) at two healthcare facilities in Lusaka, Zambia: Kanyama First Level Hospital (KFLH) and Matero Urban Health Centre (MUHC) (N=40). The FGDs were divided into three groups of male participants and three groups of female participants. Using a semi-structured guide informed by the Information-Motivation-Behavioral Skills (IMB) model, we explored factors influencing ART adherence, including education, motivation, and structural barriers. Thematic analysis was conducted using the Framework Method to identify key gender-related differences in adherence challenges.

Results: Gender-based disparities in ART adherence were evident. Young women reporting heightened stigma, limited autonomy in healthcare decision-making, and experiences of gender-based violence as major barriers. In particular, stigma is linked to fears of involuntary disclosure of their HIV status within relationships. Participants expressed concerns about their partners' reactions, including potential violence and lack of understanding about viral load and treatment. Economic dependence on partners or family members further limited young women’s ability to access care, often restricting their ability to attend clinic appointments independently. For drivers of ART adherence, many female participants identified motherhood as a significant factor improving their medication consistency. Broader structural barriers, including poverty and stigma across social settings, were challenges shared by both young men and women.

Conclusion: These findings highlight the need for gender-sensitive interventions to improve ART adherence among YLHIV in Zambia. Next steps in our study will involve a youth-friendly mobile health (mHealth) motivational text messaging (MTM) intervention that will address stigma and incorporate gender-responsive approaches to mitigate structural barriers and support sustained ART adherence among YLHIV in Zambia.