Background: HIV positive individuals may or may not have fertility desire to have children. But the extent of these desires and how it varies by individual, social, health and demographic characteristics is not well understood. Objective: To assess fertility desire and its associated factors among HIV positive women in Gondar referral hospital, Northwest Ethiopia; 2019. Method: Institutional -based cross-sectional study design was conducted from May-June 2019 on 351 HIV positive women at Gondar comprehensive specialized referral hospital. Interview based, pre-tested and structured questionnaires was used to collect the data. Data consistency was checked and entered into Epi-info seven then exported to SPSS versions 20 for further analysis. Bivariable and multivariable logistic regression was used to determine the association between dependent and independent variables. P-values less than 0.05 with 95% CI was taken to declare a statistically significant. Result: Among study participants, 183(52.1%) HIV positive women had fertility desire. Women in the age 15-19 years (AOR: 6.88, CI=1.84-25.79), being married (AOR: 4.42, CI=1.47-13.28), unable to read and write (AOR: 0.39, CI=0.18-0.82), having no partners fertility desire and discussion with health care provider (AOR: 0.04, CI=0.02-0.12) and (AOR=0.31, CI=0.17-0.57), respectively were significantly associated factors. Conclusion: Being young age and married, educational status of women, partner desire and discussion with health care provider were obtained as significant factors of fertility desire. Hence health care providers have to give health information and education about fertility desire and other reproductive issue to clients. Keywords : ART users, women, Fertility desire, Gondar, Ethiopia.