The East African Journal of Social Sciences and HumanitiesThe government of Tanzania initiated the rollout of free antiretroviral therapy (ART) to reduce mortality and morbidity rates and improve the quality of life for people living with Human immunodeficiency virus and acquired immune deficiency syndrome (PLWHA). The initiative will be successful once the services are widely accessed and register a high level of ART adherence by PLWHA. There are however, limited empirical studies on how gender-related factors affect access to and follow-through treatment for HIV and AIDS hence the need to fill this knowledge gap. The study adopted a cross-sectional design to collect data using a structured questionnaire in Njombe Region, Tanzania. The findings reveal that heterosexual intercourse with a spouse was the leading cause of HIV transmission for women (64.9%), and casual sex outside of marriage was the major cause for men (54.3%). It was revealed that 45.5% of respondents reported women to be responsible for income generation at the household. The study found that 81.4% of women, compared to 42.9% of males walked to the clinic while only 14% of women paid for transport to get to the clinic, compared to 40% of men. It was found that 30% of women and 17% men had no access to a special diet required by the PLWHA. Findings indicate that 96.6% of females and 85.6% of males patients took their medication as prescribed and attended scheduled clinics (97.1% of men and 93.8% of women) as planned. Heavy household workload was reported to constraint women in taking medication on time. Maintaining a good diet was a problem reported by most of the respondents, especially women. The study concludes that as treatment programs are rolled out and scaled up, household gender relations still affects adherence in different ways, therefore considering gender aspect will improve access and adherence to ART for PLWHA.