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Close to 1.3 million Ethiopian live with HIV/AIDS out of which majorities are young men and women in reproductive are group. People living with HIV/AIDS have fertility desires and demand for family planning (contraceptive use). ART is being introduced to the national package of HIV/AIDS related services and quality of life or HIV positive individuals is improving as a result of the ART. The objective of this study to assess fertility decision and need for family planning of HIV positive individuals on follow up care in Adama ARV treatment unit. The high levels of fertility desire {47%} among HIV positive individuals have important implication for the current national efforts to prevent vertical and heterosexual transmission of HIV. The concerned bodies should address the need for counseling to facilitate informed decision making about child bearing, social services for children born to infected parents.