Abstract
Antiretroviral therapy (ART) has transformed HIV into a chronic condition; however, living with HIV extends beyond biomedical control. This interpretative phenomenological study explored how people living with HIV (PLHIV) construct the meaning of ART. Semi-structured interviews were conducted with twelve PLHIV receiving ART (5 gay men, 3 heterosexual men, and 4 heterosexual women), with investigator triangulation enhancing analytic rigor. Analysis generated one superordinate theme with four themes describing participants' evolving experiences of ART across their illness trajectory. ART initiation emerged as a negotiated process shaped by medical guidance, personal beliefs, and fears, representing an early stage of illness reconstruction. Trusting relationships with HIV physicians facilitated treatment engagement, whereas stigma, disclosure, treatment-related challenges, and persistent uncertainty regarding U = U continued to shape participants' experiences. Participants progressively integrated ART by reconstructing its meaning in relation to identity, relationships, and future aspirations. Although all participants described treatment as enabling health and a renewed sense of normality, the pathways through which this normality was reconstructed differed across subgroups. ART was experienced as the foundation of a treatment-dependent normality, through which participants adapted not by eliminating uncertainty but by integrating it into a renewed sense of everyday life.