Objective: To assess the initiation of antiretroviral therapy with respectto gender at the Brazzaville Ambulatory Treatment Centre, Republic of Congo (CTA). Methods: A retrospective cohort study of HIV-positive patients enrolled at the CTA between january 2005 and december 2006 with 4 years of follow-up up until December 2010. The primary endpoint was the proportion of patients initiating antiretroviral therapy (ART) among those meeting the conditions for ART. We investigated the factors associated with initiation of ART using multiple Cox regression models. Kaplan-Meier curves were used to estimate the proportion of patients initiating ART. Results: A total of 1,012 patients with a median age of 38.15 years (IQR: 31.81 – 44.54) were included. Eight hundred fourteen patients (84.8%) had baseline CD4 count < 200 cells/mm3 and 604 patients (59.7%) were at WHO clinicalstage III and IV. 64.82 % of these patients were women. Five hundred and forty-two (53.56%) patients received ART and the median time to initiation of ART was 28.42 weeks. Men (aHR: 1.56; 95%CI = 1.13 – 2.16; p = 0.007) and patients with baseline haemoglobin above 10g/dL (aHR: 1.68; 95%CI: 1.25 – 2.27; p = 0.001) were more likely to initiate ART. Conclusion: Patients admitted to the Brazzaville Ambulatory Treatment Centre were predominantly women with irregular monthly income. Being a man and having a baseline haemoglobin greater than or equal to 10 g/dL were associated with more rapid initiation of antiretroviral therapy.