This article investigates the implementation of antiretroviral therapy (ART) in urban Tanga, Tanzania. First, the enrollment procedures of the national treatment program and medical professionals' techniques to produce adherent patients are examined. Second, exemplary case studies of patients and their families are explored to depict varying responses to the increasing medicalization of everyday lives through the therapy's rigid treatment regime. I argue that the observed disciplinary power exerted on users of antiretroviral medicines throughout treatment preparation and surveillance contrasts with the emergence of ‘therapeutic citizens’ as described in the wake of ART introduction in other African settings. There are also frictions between propagated biomedical truths and ‘rational’ lifestyles, on the one hand, and patient reasoning on the other; the latter being strongly influenced by perceived gender roles, economic constraints, and the struggle to maintain mostly kinship-based support networks.