This study presents evidence linking the spread of Human Immunodeficiency Virus (HIV) with gender inequality in law and in custom in Pacific Island countries and territories. The subject of HIV and Gender is sensitive and cannot be discussed without the use of explicit language and without plainly stating the facts. It suggests recommendations based on the findings in five areas (listed below), proposing policy responses and programme approaches which can and should be fundamental to fighting the spread of HIV in Pacific Island countries and territories.