Although alcohol use is common among persons living with HIV/AIDS (PLWHA), and heavy drinking is more common worldwide in males than females, studies of sex differences in risk for development of symptoms of alcohol dependence have yielded mixed results. In Nigeria, there is a paucity of data on sex differences in alcohol-related problems among PLWHA. This has hindered our ability to tailor treatment to best meet the needs of PLWHA. To address this gap, the present study examined alcohol use patterns and Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV)-related symptoms in a sample of 331 HIV and AIDS patients (64.4% female; Mage = 38.1 years, SD = 9.1 years) recruited from Lagos State University Teaching Hospital Ikeja. The World Health Organization Composite International Diagnostic Interview (WHO-CIDI), Version 7.0, was administered to assess alcohol use and DSM-IV-related symptoms. Based on responses to the interview, patients were classified as having or not having complication(s) or symptom(s). Logistic regressions adjusting for age and marital status revealed that women were at lower risk than men for alcohol-related problems. Symptoms of craving and tolerance did not differ across sex. Study findings support the need for policy to be geared toward sex-specific prevention and harm-reduction approaches among HIV-positive individuals.