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This study explores how living with HIV affects fertility desires and reproductive identities in a context where HIV is highly stigmatised and parenthood is highly valued. We conducted interviews with 30 women and 30 men living with HIV, and 30 health care providers in Iringa, Tanzania. Using the conceptual framework of biographical disruption, we analysed interviews to characterise strategies participants living with HIV employed to regain a sense of normalcy. We found that living with HIV had consequences that disrupted notions of reproductive identity and that these disruptions influenced fertility desires and safer conception planning of both women and men living with HIV. Some participants relinquished the desire for children altogether, while others maintained the role of procreator as a strategy to conceal their HIV status and maintain their value in society. Perceptions of normalcy and notions of reproductive identity following an HIV diagnosis shape how people living with HIV navigate fertility decision-making in the face of biographical disruption. Findings can inform HIV programming to help those living with HIV regain a sense of normalcy by fostering solidarity, reducing community-based stigma and promoting safer conception for those who desire children and effective contraception for those who do not.