Background Evidences in sub-Saharan Africa including Cameroon indicate that most of HIV discordant couples want more children despite their HIV status. Investigate and establish contraception preferences among HIV infected individuals are fundamental and crucial to provide effective reproductive healthcare.Methods We performed a cross-sectional study using structured questionnaire to explore HIV-positive pregnant women patterns including their family planning services, their preferences and its use, and their knowledge related to HIV/AIDS. Bivariate and multivariate analyses were conducted to explore associations and predictors of contraception preference and use; all tests were two sided significant at P < 0.05.Results Overall, 94 HIV-positive pregnant women aged 30.70±5.50 years living with HIV-negative partners were from the different areas of the central region of Cameroon. Three-fourths were aware of the effectiveness of modern contraceptives and condoms, and only 28% had experienced modern contraption. 98% preferred to use traditional methods associated with infrequent condoms use. Multiple sociodemographic factors (marital status, group age, educational level, religion, occupation) affected contraceptive method preferences and its use ( P <0.05). These factors are the landmarks to predict discordant couples’ behavior in HIV disclosure, discussion and decision making for contraception, preventing mother to-child transmission and HIV-negative partner infection ( P <0.05).Conclusion Despite the awareness of participants related both on contraception methods and HIV/AIDS matters, participants faced societal, cultural and demographic barriers to make own decision for contraception use. Promoting effective family planning services and given the entire range of contraception options may help women living with HIV to choose for effective ones and consequently reduce newly HIV infections.