Background: The Africa especially the region of Sub-Saharan remains the severely HIV affected region with nearly 1 in every 20 people. The majorities of people living with HIV are of reproductive age and face challenging choices concerning their sexuality, parenthood desires and family life. Despite the desire to avoid having children, many women with HIV experience unintended pregnancies. Prevention of unintended pregnancies among HIV infected women is one key strategies of prevention of mother to child transmission of the disease in the country. Methods: A non-experimental facility based cross sectional study design was used and the data was collected from all men and women attending care and treatment in ART clinics in selected health facilities giving ART service from January to February 2014. A pre-tested structured questionnaire was employed to collect information from respondents who fulfill inclusion criteria and after obtaining a verbal consent. Data was entered, cleaned, edited and analyzed using SPSS Version 20 statistical software package. Chi-square and binary logistic regression was carried out to assess the presence of association and the effect of independent predictors on fertility desire of the respondents. Result: A total of 410 Patients were included in the study giving the response rate of 97 percent. The median age of respondents was 33 and 254(62%) of clients were females. 43% (176) desire to bear child and of these 34 % were not using any modern FP method. The most commonly reported reasons for child bearing desire were desire to replace themselves 65.9 % followed by desiring a child from their partner 17.1%. Among respondents do not desire to bear child, 45.6 % were males and 55.4 % were females. It was found that sexual practice in the last six months [AOR: 2.07, 95% CI, 1.63-7.26], number of live children (AOR: 0.5, 95% CI, 0.105-0.217), and number of children alive [AOR: 4.61, 95% CI, 2.94-13.77], were found to be significantly associated with desire to bear children. Conclusion: Fertility desire is found to be high among HIV/AIDS patients living in the study area. Age, having sexual practice in the last six months, and having less number of children alive, were obtained to be the determinants of fertility desire. The current contraceptive utilization rate of the respondents was less and majority of them were using condom which is not a reliable method for the prevention of pregnancy so most of them especially those who does not desire more children will be exposed to unwanted pregnancy. The most common reason of respondents who desire to have a child was to replace them followed by desiring a child from their partner.
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