Little information exists about desire to have children and family-planning use among HIV-positive individuals and how this may vary according to individual, social, health and demographic characteristics, especially in developing countries. To assess these topics in Ethiopia, a facility-based cross-sectional study was undertaken among 460 HIV-positive individuals receiving follow-up care at antiretroviral treatment (ART) centres in six public hospitals in Addis Ababa in 2006. One hundred and nine of the women (44.7%), 76 of the men (35.2%), and 40.2% overall of the HIV-positive individuals receiving care desired to have children. In comparison to those who said they did not desire to have children, those who did desire children tended to be younger (18–29 years) (adjusted odds ratio [OR]: 3.05, 95% CI: 1.5–6.4), married or in a relationship (adjusted OR: 3.4, 95% CI: 2.1–5.6), without a child (adjusted OR: 11.5, 95% CI: 5.3–24.9), and with a partner who also desired to have children (adjusted OR: 38.7, 95% CI: 16.7–89.1). Two hundred and forty-six individuals (53.5%) were using family planning (e.g. condoms, abstinence, injectables) and 85 wanted to use family planning in the future. The fertility desire and family-planning needs of these ART clients have implications for preventing vertical and heterosexual transmission of HIV, and the need for appropriate counselling and delivery of services.