We designed a randomized controlled trial of a home based intervention to improve antiretroviral adherence and to assess the impact of depressive symptoms among people living with HIV in Hunan, China. At baseline, 110 subjects reported taking 90% or less of prescribed medication. At 6 months, when the intervention ended, 56% of subjects in the control and 87% of subjects in the experimental group were adherent. This difference was maintained at 12 months. In multivariate analyses, controlling for baseline visual analogue adherence scale, stigma, social support, and Center for Epidemiological Studies Depression scale, the experimental group had a significantly higher proportion of people who were adherent (p=0.009). The high prevalence of significant depressive symptoms (67%) at baseline is of concern. It is of particular importance that future studies look at the types of depression likely to be seen in these patients and differentiate early between those likely to benefit from HIV-related support and those who will require additional depression-targeted interventions.