Background: Despite the benefit and promotion of exclusive breast feeding, the rate of excusivernbreast feeding is still low in Ethiopia. Thus, this study will assess factors that lead to nonadherencernto exclusive breast feeding among HIV positive mothers.rnObjective: the main objective of this study was to assess the prevalence of exclusive breastrnfeeding and factors that influence its practices among HIV positive mothers of infants aged 6-24rnmonths old who are on chronic HIV care in selected health facilities of Adama town.rnMethod: Institution based cross-sectional study was conducted among 193 HIV positive womenrnwith infant aged 6-24months in three health facilities (Adama hospital, Geda and Adama healthrncenters) of Adama town in Ethiopia. Data was collected using structured and pre-testedrnquestionnaires. Four data collectors and three supervisors were trained and involved in datarncollection process. Data were entered and analyzed using SPSS version 20 statistical softwarernpackage. Univariate analyses were done to determine various proportions and bivariate analysisrnwas conducted to measure the existence and the strength of an association between the dependentrnand the independent variables. Level of significance was set at a p value of â‰¤ 0.05. Variables thatrnhad less than 0.05 level of significance were further analyzed in multiple logistic regressionrnmodels to control the potential confounding variables.rnResults: In this study the prevalence of exclusive breast feeding, exclusive replacement feedingrnand mixed feeding and factors associated with exclusive breast feeding was determined. Thernresult showed that exclusive breastfeeding, exclusive replacement feeding, and mixed feedingrnwere 84.7%, 3.2 %, and 6.3 %, respectively. Exclusive breast feeding was more practiced byrnmothers who had adequate knowledge on exclusive breast feeding (Adjusted OR = 6.84(2.54,rn18.44)), mothers who disclosed their HIV status to their husbands/spouses (Adjusted OR=rn3.80(1.28, 11.28)), and mothers who attained below primary level of education (Adjusted OR =rn3.89(1.41, 10.70)).rnConclusion and Recommendation: Despite more than three-quarters mothers who adhere tornexclusive breastfeeding, the rate is still not satisfactory. More extensive and comprehensivernapproach of infant feeding counseling should be put in place in order to increase exclusivernbreastfeeding by HIV positive mothers. Moreover, both partners should be counseled properly onrnthe issue to get the support from their male partners.rnKeywords: Exclusive breast feeding, replacement feeding, mixed feeding, HIV positive women