Back ground: Reproductive health issues appear to be relatively neglected among HIV positivernwomen. Hence the contribution of contraception as a strategy to reduce mother-to-childrntransmission is underutilized. As well, there are few incites and substantive data on the magnitudernof unmet reproductive health care needs and occurrence of unintended pregnancy among HIVrnpositive women is not available in Ethiopia (Addis Ababa).rnObjective of the study: This study assessed unmet reproductive health care needs andrnoccurrence of unintended pregnancy among HIV positive women enrolled in the ART units.rnMethodology: The study was undertaken from December 2010 to Feburary2011 usingrnquantitative cross sectional facility based study supplemented by qualitative in-depth interview onrna sample of 548 HIV positive women in the ART follow up units in Addis Ababa. A systematicrnrandom sampling procedure was applied to select study participants. A pretested structuredrnquestioner was used to collect data and the data was analyzed using SPSS version 11.rnResult: Unmet need for contraception in the study was 31%: 25% for spacing and 6% forrnlimiting. Generally, HIV positive women who had a higher chance of unmet need forrncontraception were those with sero discordant partner (adjusted OR: 2.4, 95%CI: 1.04-5.64) andrnwomen who had faced unintended pregnancy after being HIV positive (adjusted OR: 10.12,rn95%CI: 4.6-22.3). Whereas, women with recent CD4 count >200 were less likely to have unmetrnneed for contraception than CD4 count of â‰¤ 200 (adjusted OR: 0.257, 95% CI: 0.09-0.70).rnThe proportion of unintended pregnancies among the total pregnancies during the post HIVrndiagnosis period were 147 (46%); of which 125 (38%) mistimed and 22 (8%) unwanted. In arnmultivariate analysis, HIV positive women who have unmet contraceptive (adjusted OR: 14.9,rn95%CI: 4.8-46) and those who had ever used emergency contraception (adjusted OR: 4.1,rn95%CI: 2-9.2) were having a significantly higher chance of experiencing unintended pregnancy.rn11% of the women had ever discussed emergency contraception and discussion of saferntermination of pregnancy was (8%) with the provider while contraception and condom were mostrndiscussed with the provider as reported by 78% of the respondents. Unmet need for saferntermination of pregnancy was 37%.rnConclusion: Unmet contraceptive need and of reproductive counseling and safe termination ofrnpregnancy were high among HIV positive women in the ART units. As a major manifestation ofrnthese, occurrence of unintended pregnancy was significantly higher among HIV positive womenrnin the ART care units in Addis Ababa; which has implications for vertical HIV transmition. Thesernindicating the need to sought new strategies to address reproductive health care services andrnhence to satisfy reproductive health care needs of HIV positive woman.