Background: Non-compliance with antiretroviral drugs (ARD) remains a significant barrier to achieving viral suppression among people living with HIV/AIDS, particularly in resource-limited settings like northern Nigeria. Despite the availability of free antiretroviral drugs through public health facilities, many patients fail to maintain the optimal adherence levels required to prevent treatment failure, drug resistance, and disease progression. This study was conducted to investigate socio-economics influence on adherence to antiretroviral drugs among HIV/AIDS patients attending the Antiretroviral Clinic at General Hospital, Gusau, and Zamfara State.

Methodology: This study employed a descriptive cross-sectional survey design to investigate the socio-economic factors influencing medication adherence among HIV-positive adults aged 18 and above at General Hospital Gusau. The study targeted patients with at least three months of experience on Antiretroviral Therapy (ART), utilizing a sample size of 188 respondents determined by Yamane’s formula from a total population of 300. Participants were selected via systematic random sampling to ensure an unbiased and representative sample, and the resulting data were analyzed through descriptive statistics, including frequencies, percentages, and mean scores, summarize participant characteristics and the primary drivers of treatment non-compliance

Results: The study identifies transportation cost and poverty as the most critical barrier to treatment adherence (Mean = 3.04), with 74.5% of respondents missing medication due to travel costs, underscoring that the financial burden of accessing "free" care remains a major deterrent. Beyond economic factors, lack of social support (Mean = 2.87) and geographical distance to clinics (Mean = 2.73) significantly impede compliance for over 60% of patients, highlighting the need for decentralized care and stronger community networks. Furthermore, while occupational demands and low literacy levels also play a role, the overarching data suggests that structural and economic challenges, rather than a lack of patient willingness, are the primary drivers of non-compliance among ART patients in Gusau.

Conclusion: Non-compliance to antiretroviral drugs among HIV/AIDS patients at General Hospital, Gusau is not caused by a health systems factor but rather a socio- economic factor, medical intervention alone is insufficient. For HIV management in Zamfara State to be successful, clinical care must be integrated with economic support programs, decentralized drug delivery systems, and community-led social support initiatives to mitigate the harsh socio-economic realities currently hindering patient’s compliance to ART.