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Administration of antiretroviral therapy (ART) to HIV-infected patients is a major public health priority in resource-limited settings. Emerging data from resource-limited settings suggest that rates of ART adherence are comparable to those reported in European and North American countries. However, data on initial acceptance of ART and factors affecting adherence are very limited. We assessed the influence of lipodystrophy (LD) and the use of traditional medicine (TM) on acceptance of and adherence to ART among HIV-infected subjects in Tanzania eligible for treatment. ART eligible subjects who had either accepted or refused ART were interviewed and examined to: a) assess their use of traditional medicine, and b) identify perceived (patient self report and physician examination) and objective (anthropometric measurement-based) features of LD. Concern about lipodystrophy was reported to affect acceptance of ART by 19 patients (36%) who accepted ART (p < .01) and affect adherence to ART amongst 3 patients (6%) who accepted ART. Perceived features of lipodystrophy were noted by 39 patients (75%) who accepted ART and 11 patients (21%) who refused ART (p < .01). Traditional medicine was used by 50% of subjects in both groups and affected ART acceptance in: a) 11 (21%) of patients who refused ART, b) 7 (13%) of patients who accepted ART. Features of LD are common among patients on ART in Tanzania, and we believe that it may have a substantial effect on ART acceptance but not ART adherence. TM use is common, and it may also have a modest effect on both ART acceptance and adherence.