A case-control study was conducted from November 2003 to January 2004 to investigate thernassociation of socio-demographic variables with VCT use and to assess determinants of VCTrnservice utilization using both Quantitative and Qualitative methods of data collections.rnA total of 636 individuals (212 cases and 424 controls), who came to health institutions thatrndeliver VCT services in Guraghe Zone, were enrolled in the study. Twelve (5.7%) of cases andrn82 (19.3%) of controls (non-VCT users), 94 (14.8%) of the total study subjects had not havernheard of VCT in general. The main reason for VCT utilization among cases was pre-marital 160rn(75.5%) and the main reasons for non-use among controls were partner-and self-trust (23.1%),rnno information about it (17.8%), other social reasons (13.7%) and lack of nearby servicesrn(13.0%).rnThe majority (82.8%) of cases were in the age groups of 15-19 and 20-29 years. Studyrnparticipants were 54.7% males, 78.3% rural by residence, 54.7% followers of orthodox religion,rn80.7% Guraghe by ethnicity, 37.3% farmers by occupation, the majority (67%) had educationalrnstatus of elementary and below and 80.7% were unmarried.rnReligion, Muslim & other Christianity, secondary and above educational status, otherrnoccupational status, singleness and non-polygamous union showed statistically significantrnpositive associations with VCT utilization. Attitudes related to stigma and discrimination showedrnstatistically significant positive associations with cases but there was no statistically significantrndifference regarding knowledge and practice between cases and controls.rnixrnConfidential testing, Physicians as counselors, and face-to-face way of receiving HIV VCT testrnresult were the preferred VCT schemes by most respondents and FGD participants.rnMost health institutions do not have referral system for social support, targeted VCT, follow uprntraining and supervision, referral for indeterminate HIV VCT test results.rnMaximizing pre-marital VCT with proper information dissemination targeting the ruralrncommunity, involving all possible stakeholders and using local resources, follow-up trainingrnand supervision and setting up referral systems are recommended.rnKey words: VCT utilization, Case-Control, Stigma, Discrimination, Service quality