Sociodemographic Determinants and Gender Disparities in Hiv infected patients among rural population in Eastern Cape South Africa

South Africa continues to experience the highest global HIV burden, with rural provinces like the Eastern Cape facing stark disparities in access to care. This cross-sectional study examined sociodemographic determinants among 218 HIV-infected individuals across seven facilities in OR Tambo, Joe Gqabi, and Alfred Nzo districts between February 2019 and February 2021. HIV status was confirmed using Determine™ and UniGold™ Rapid HIV-1/2 tests. Among females, 57.6% were single, 27.3% married, and 10.1% widowed. For males, 47.4% were single or married, with no widowed or cohabiting individuals recorded. Smoking was similar across genders (females: 9.6%; males: 10.5%), while alcohol use was notably higher among males (36.8%) than females (14.1%). Odds ratio (OR) analysis revealed that males had 44% lower odds of being on ART above age 35 (OR: 0.56; 95% CI: 0.21–1.52). Males were more likely to be single (OR: 1.51), while females had higher odds of being unemployed (OR: 0.48). Notably, males had over three times the odds of alcohol use compared to females (OR: 3.54; 95% CI: 1.28–9.77). These findings highlight persistent gender and socioeconomic disparities, underscoring the need for tailored, community-level HIV interventions to meet the UNAIDS 95-95-95 goals and national HIV response strategies.