Background: Risk factors for HIV transmission in sub-Saharan Africanrnincluding Ethiopia are the same as other countries in the region. However,rninformation on risk factors associated with HIV infection among HIV-VCTrncenters attendees are insufficient to make useful recommendations onrnHIV/AIDS prevention and control in Harari region; therefore assessment ofrnhigh risk behaviors for HIV transmission in this regard is useful.rnObjective: To assess the level of HIV-risk behaviors and their association withrnHIV infection among HIV -VCT centers attendees in Harari region.rnMethods: An unmatched case-control study was conducted among HIV-VCTrncenters attendees from Sep 2008 to May 2009 in all health facilities providingrnHIV-VCT services in Harari region. A total of 429 participants grouped in torncases (n=143) and controls (n=286) were recruited and assessed for variousrnsocio-demographic and other important health variables. The assessment wasrnsupplemented with Focus group discussion two in each sex. The quantitativerndata were entered and analyzed using SPSS Version 15. The descriptivernstatistics was used to show the magnitude of various characteristics. Bivaraternanalysis was used to see the association of different variables. Odds ratio withrn95% CI was computed to assess the presence and degree of associationrnbetween variables. Step wise logistic regression analysis was also applied tornidentify the important HIV-risk behaviors among HIV-VCT attendees. Thernqualitative data was analyzed using thematic analysis approach.rnResult: A total of 429 HIV-VCT attendees, of which 143 cases and 286 controlsrnwere participated. Of the 139(97.2%) cases and 219(76.6%) controls who everrnhad sex, 108(77.7%) cases and 136(62%) controls had two or more life timernsexual partners. Sexually experienced 93(66.9%) cases and 184(84.0%)rncontrols reported having sex in the 12 months preceding the study. Of thosernwho had sex in the last 12 months, 29(31.2%) of cases and 13(7.1%) controlsrnhad history of STIs. 14(28.6%) of male cases and 10(11.1%) male controls hadrnsex with CSWs in the last 12 months, of which 6(42.9%) of cases and 5(38.9%)rncontrols had reported inconsistent condom use. Ever had sexual intercourse,rnhaving two or more life time sexual partners and having history of STIs in thernlast 12 months were positively and significantly associated with HIV infection.rnThis finding was strengthened by qualitative study where the majority of therndiscussants in both sexes agreed on unprotected sex, having two or more liferntime sexual partners and history of STIs as the risk sexual behaviors.rnConclusion and recommendation: The major HIV-risk factors identified arernever had sexual intercourse, having two or more life time sexual partners andrnhaving History of STIs in the past 12 months. These findings suggest a need forrndesigning HIV/AIDS prevention strategy focused on: reduction in number ofrnsexual partners, improved sexually transmitted infection prevention andrncontrol, and an increase in condom use. In addition, prevention efforts shouldrnfocus on high risk groups, particularly in urban areas where the HIVrnprevalence is higher such as daily laborer and housewives.