Background: Antiretroviral treatment is imperative for increasing survival among HIV positive individuals. Treatment success is assured by strict adherence to antiretroviral therapy (ART) resulting in improved quality and quantity of life. Aim: To compare visual analogue scale (VAS) (self-report) adherence with pill counts adherence reports of individuals receiving HIV treatment in a rural faith-based clinic while evaluating the relationships between those two adherence measures with medication side effects, food insecurity, demographic characteristics, and socialpsychological constructs. Methods: This is a non-experimental cross-sectional study of a convenience sample of 200 reproductive age HIV positive women on ART at a faith-based clinic in Makwasa, Thyolo District, Malawi. Pill counts, VAS adherence, and other constructs measurements were taken from November to December 2013. Bivariate analysis was used to test the association between the two adherence outcomes and background factors and univariate logistic regression (ULR) models were used to explore the association of each variable to the two adherence outcomes; and multivariate logistic regression (MLR) was used to examine the association between outcome variables and adherence determinants. Results: Mean pill count adherence was 79.00 ± 29.66 compared to 96.55 ± 14.21 for VAS adherence. Household food insecurity (OR=1.40; P=0.01), individual food insecurity (OR=1.54; P=0.00), and self-efficacy (OR=2.93; P≤0.00) were significantly associated with pill count in the ULR. Household (OR=0.44; P=0.00) and individual food insecurity (OR=0.38; P=0.003), self-efficacy (OR=0.35; P=0.04), subjective norms (OR=0.24; P=0.02), and attitude (OR=0.34; P=0.04) were associated with VAS adherence in the ULR. In the multivariate, self-efficacy (adjusted) was associated with pill count, while attitude (adjusted) was associated with VAS adherence. Conclusions: The study showed that a gap existed between VAS adherence and pill counts adherence indicating the participants verbally overestimated their adherence. Additionally, intervention focusing on food supplements would be useful for improving poor adherence associated with food insecurity.