Background In Kenya, there are over one million adults of reproductive age living with HIV/AIDS. The unmet need for contraceptive use is sixty percent for HIV positive women. Increased availability of HAART has resulted in improved physical and sexual health, resulting in increased of risk of intended and unintended pregnancies. Understanding the fertility desires of this vulnerable group becomes paramount.

Methods Eligible HIV infected adults enrolled for care at Naivasha district hospital CCC completed a structured questionnaire after providing written consent. Chi squared tests and T tests were performed to determine predictors of fertility desire.

Results Three hundred men and three hundred women were recruited. Fertility desire was reported by forty-nine (sixteen percent) women and sixty-seven (twenty-four percent) men. HIV positive women were less likely to desire more children compared to HIV males. Among the demographic characteristics only the number of living children and women not on HAART were significantly associated with fertility desire. Among the two hundred and forty-eight women who did not desire fertility, one hundred and eighteen (forty-seven percent) were not using contraception. Overall, eighty-five percent of men and fifty-five percent of women were sexually active. Males (forty-six) were more sexually active than women (one hundred and twelve) among those not desiring fertility and not using contraceptives, seventy-two percent males and fifteen percent women.

Conclusions Only twenty percent of HIV infected adults’ desired fertility, with men being pronatalist than women. Only about half of HIV positive women were using contraceptives despite having no fertility desire. This increases the risk of unintended pregnancies. Sexual activity was ongoing with no contraceptive use hence increasing the risks of vertical and horizontal transmission on HIV. Integration of Family planning services in CCC’s should be considered.