In this article, we use a synthesis of findings from four studies we have conducted to argue that gender issues influence people's access to HIV testing and counselling services, as well as their access to antiretroviral therapy (ART) services. Gender issues also influence the costs, including opportunity costs, of using and adhering to HIV treatment. In addition, stigma - which affects use and adherence to treatment - is experienced differently by HIV-positive women and men. We argue that attention to gender issues is critical to ensure equitable and sustainable HIV service provision. Thus, gender analysis must inform the design of monitoring and evaluation strategies, and research into the operation of programmes.