The purpose of this grounded theory study was to explain how ethnically diverse men and women living with HIV manage their interacting illness symptoms, medication side effects, and treatment adherence choices. The authors used the constant comparative method to analyze textual data from in-depth interviews with 66 HIV-infected people representing the changing HIV demographic profile in the San Francisco Bay area and generate a theory of Reconciling Incompatibilities. Adherence options of complying, not complying, or self-tailoring occurred in a context of attributional uncertainty as to whether distress was illness- or treatment-related, a sometimes silent virus, and perceived fickle medical markers. Conditions, including self-identity, illness ideology, concurrent treatment regimens, the meaning of time, medication burden and side effects, and lifestyle, coalesced to produce a state of mind that shaped adherence choices on a dose-by-dose basis. This theory offers a basis for interventions designed to promote optimal adherence choices concerning HIV therapies.