Adherence to antiretroviral therapy, while often conceptualised as an individual or community-level concern, needs to be understood in the context of political and historical developments that have characterised many resource-constrained societies. This article identifies some of these dimensions of antiretroviral therapy adherence in South Africa and outlines the implications for community health psychology in taking this perspective. Using the conceptual apparatus of therapeutic citizenship, we demonstrate the importance of historical, political and other structural barriers to adherence. We conclude by examining the implications of these debates for community health psychology that go beyond the individual as the unit of intervention and analysis.