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Despite recommendations for rapidly initiating HIV treatment, many persons in sub-Saharan Africa present to care with advanced HIV disease. Baseline survey and clinical data were collected on 1799 adults newly enrolling at 32 district hospitals and local health HIV clinics in rural Ethiopia. Among those with complete HIV disease information, advanced HIV disease (defined as CD4 count <200 cells/mm 3 or World Health Organization [WHO] HIV clinical stage III or IV disease) was present in 66% of males and 56% of females ( P < .001). Males (compared to females) had lower CD4 counts (287 cells/mm 3 versus 345 cells/mm 3 ), lower body mass index (19.3 kg/m 2 versus 20.2 kg/m 2 ), and more WHO stage III or IV disease (46% versus 37%), ( P < .001). Men reported more chronic diarrhea, fevers, cough, pain, fatigue, and weight loss ( P < .05). Most initiating care in this resource-limited setting had advanced HIV disease. Men had poorer health status, supporting the importance of earlier diagnosis, linkage to care, and initiation of antiretroviral therapy.