Background: In a setting with high HIV prevalence and high fertility rates, addressing fertility issues of People Living with HIV/AIDS (PLWHA) is crucial. However, understanding of the factors associated with fertility decisions of PLWHA in Ethiopia is remarkably low. Objective: The study was conducted to assess factors associated with fertility decisions of PLWHA in South Wollo Zone, Northeast Ethiopia. Methods: The study was conducted from February 1 to March 30, 2008 using cross-sectional design. Quantitative data were collected from a sample of 458 men and 458 women using structured questionnaire. Qualitative data were also collected from six health care providers. During in-depth interview the health care providers indicated the fertility related counseling service to be low. Conclusion:In spite of the fact that significant proportion of married PLWHA had decided to have a child, the fertility related counseling service is low. Improving fertility related counseling services to enable clients make informed fertility decision is mandatory. The factors identified to be associated with fertility decision could be of major importance and as such should be investigated further. [Ethiop. J. Health Dev.2010;24(3):214-220]