Objectives: There exists a strong relationship between gender and HIV/AIDS, with gender inequalities contributing to HIV, and HIV/AIDS in turn worsening gender inequality. In Sub-Saharan Africa only few studies have examined gender differences in HIV status disclosure. Therefore this study explores gender differences in HIV- positive status disclosure. Methods: A facility based cross-sectional study using qualitative and quantitative data collection methods was conducted among 705 randomly selected HIV positive service users in South West Ethiopia. Data were collected using a pre-tested interviewer-administered structured questionnaire. Gender specific factors associated with disclosure to a main partner were analyzed using logistic regression. Results: Among 705 participants, an equal number of men and women (94.6% men vs. 94.3%, women, p=0.876) indicated that they have disclosed their result to at least one individual and the majority (90.9% men vs. 90.7% women, p=0.906) disclosed their result to their current main partner. It is customary to tell my partner everything was the frequently cited motivator for disclosing (36.3% men vs. 44.6% women, p=0.147). Reasons for non-disclosure varied by gender: men are more tender-hearted about their partners while women are more pragmatic. The individual contextual meaning of fear of partner reaction entirely differs between men and women. Men were concerned about their partner’s worry and exposure of their own unfaithfulness. Women feared physical violence and social and economic pressure in raising their children. For men, disclosure of HIV results to a sexual partner was positively associated with knowing the partner's HIV status and discussion about HIV testing prior to seeking services, while for women it was associated with knowing the partner's HIV status, advanced disease stage, attending no more than primary education, being married, and perceiving the current relation as long-lasting. Conclusion: In this study there was no significant difference in the proportion of HIV status disclosure among men and women. However, the contextual barriers and motivators of disclosure varied by gender. Therefore future interventions should consider the importance of socially constructed gender roles in the efforts to increase HIV status disclosure.