Abstract This paper explores the gender dimensions of access to highly active antiretroviral therapy (HAART) in South Africa. It shows that women are more vulnerable to HIV infection than men, but that women access HAART in disproportionately large numbers. Regression analysis on data from the South African Demographic and Health Survey suggests that men in general access health services less readily than women. This ‘masculinity factor’ accounts for most of the difference between men and women when it comes to accessing HAART. Although men were more likely to favor traditional medicine than women, this was not a statistically significant factor, and it appears that visiting a traditional healer is complementary to, rather than a substitute for, accessing HAART. In short, it seems that gendered norms that make it difficult for men to admit weakness and seek medical attention are the main probable cause for the low proportions of men accessing HAART.