Background: Sexual and Reproductive needs and preferences of HIV positive individuals arernchanging due to the development of antiretroviral therapy (ART) as effective for HIVrninfection. Due to improvements of symptoms and the change in quality of life PLWHA regainrntheir normal activities and new challenges and new opportunities are arising.rnObjective: The aim of this study is to assess sexual & reproductive needs and preferences ofrnPLWHA receiving antiretroviral therapy in five Hospitals of Southern Nations Nationalitiesrn& peoples Region (SNNPR).rnMethods: A cross sectional survey on 461 Patients receiving ART in five hospitals ofrnSNNPR, was carried out from February to March 2007. The data on sexual and reproductivernneeds and preferences, and other variables were collected using structured and pre-testedrnquestionnaire. A Quantitative method is supplemented by Qualitative (in-depth interview).rnResult: Two hundred twenty three (49.1%) of HIV positive individuals were found to havernsexual practice with regular partner, 191(42.1%) were abstained, 24(5.3 %) had sexualrnpractice with no or inconsistent condom use and 16(3.5%) with multiple sexual partners. Onernhundred fifty four (33.9%) of the respondents expressed their desire for children. One hundredrnsixty nine (70.4%) of the study population had ever used at least one method of contraceptionrnduring the study time, while 33(53.4%) wanted to use at least one method in the future.rnCondom and injectable are the most commonly used method of contraception in the past andrnpreferred method to be used in the future. Generally, HIV positive individuals who had sexualrnrisk were those non married & had sexual partner (adjusted OR: 6.99, 95% CI: 2.34-20.9) andrnreported alcohol use (Adjusted OR: 6.07, 95% CI: 1.87-19.7). Respondents in the age grouprn15-34 were more likely to desire children (adjusted OR: 1.91, 95% CI:1.13-3.24) than otherrnage group. Followers of orthodox Christianity were less likely to desire children than otherrnChristians (adjusted OR: 0.54, 95% CI = 0.33-0.91). Being married (adjusted OR: 1.78, 95%rnCI: 1.05-3.14), those who had risky sexual behavior (OR=1.73, 95% CI=1.02-2.95) and thosernwho reported no currently alive children adjusted (OR: 4.41, 95% CI: 1.46-13.36) were morernlikely to desire children.rnvirnConclusion: Sexual & reproductive health needs and preferences of PLWHA are not affectedrnby their HIV status. Risky sexual practice was not uncommon, high number of themrnexpressed a wish for children and wants to use family planning. To address such issues properrnpromotion & counseling of subjects is important. Moreover, National and the Internationalrnstakeholders should be coordinated for intervention.