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Purpose: Cheaper generic anti-retroviral medicines are encouraged and often prescribed in South Africa for HIV/AIDS treatment. However, the medicines' acceptance rate is relatively low. This has been attributed to inadequate brand knowledge of the bioequivalence of generic medicines. Studies have examined how brand knowledge structure lead to purchase. The contributions of brand relationship builders (i.e. trust and satisfaction), which are indicators of sustainable purchase, are rarely considered. This study aims to adapt Esch, Langner, Schmitt and Geus' (2006) brand knowledge structure and relationship model to examine the impact of South African young adults' brand knowledge structure (brand awareness, brand image and brand beliefs) and trust on brand satisfaction and purchase. Design/methodology/approach: Cross-sectional data was quantitatively collected from 207 young adults through self-administered, paper-based questionnaires. Data was analysed with structural equation modelling. Findings: Brand awareness, image, trust and belief in efficacy positively influenced purchase. All these factors, except brand awareness, positively led to satisfaction. The tested adapted model explained 53.0 and 58.5% variances of purchase and brand satisfaction, respectively. Practical implications: Considering how much brand knowledge structure and trust explained purchase and satisfaction from the tested model, South African government, pharmaceutical marketers and consumer interest groups should educate young adults about the bioequivalence, safety and efficacy of generic medicines. With greater knowledge of these qualities, satisfaction is gained from purchase decision. Originality/value: Instead of the usual examination of demographic differences in generic medicine beliefs and perception, this study contributes by revealing brand-related drivers of purchase and satisfaction. [ABSTRACT FROM AUTHOR]