In the recent scale-up of antiretroviral treatment, gender differences in access to treatment have been
reported. In Thailand, as the HIV epidemic became more generalised, there has been a shift from men
being disproportionately affected to increased vulnerability of women. In 2007, the Living with Antiretrovirals
(LIWA-ANRS 12141) study investigated the gender distribution of all adult patients receiving
antiretroviral therapy (N ¼ 513 patients) in four community hospitals in northern Thailand and factors
influencing the disparities observed. From this retrospective life-event history survey, we found that
proportionately more women (53%) were receiving antiretroviral therapy than men, an unexpected result
for a country with a higher proportion of infections among men. They were more likely to initiate
treatment within one year of diagnosis and were at a more advanced stage of the disease compared to
women. This gender distribution is partly explained by the evolving dynamics of the HIV epidemic, initial
prioritization of mothers for treatment and earlier access to HIV testing for women. These issues are also
entangled with gender differences in the reasons and timing to HIV testing at the individual level. This
study found that the majority of men underwent HIV testing for health reasons while the majority of
women were tested following family events such as a spouse/child death or during pregnancy. Further
qualitative research on gender specific barriers to HIV testing and care, such as perceived low risk of
infection, poor access to medical care, lack of social support, actual or anticipated HIV/AIDS-related stigma
would provide greater insight. In the meantime, urgent efforts are needed to increase access to voluntary
counselling and testing inside and outside the family setting with targeted interventions for men.