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Background: Scaling up of antiretroviral therapy (ART) is currently underway in sub-Saharan Africa including, Tanzania, increasing survival of people living with HIV/AIDS (PLWHA). Programmes pay little attention to PLWHA's reproductive health needs. Information on fertility desire and intention would assist in the integration of sexual and reproductive health in routine care and treatment clinics., Methods: A cross-sectional study of all PLWHA aged 15-49 residing in Kahe ward in rural Kilimanjaro Tanzania was conducted. Participants were recruited from the community and a local counselling centre located in the ward. Data on socio-demographic, medical and reproductive characteristics were collected through face-to-face interviews. Data were entered and analysed using STATA statistical software., Results: A total of 410 PLWHA with a mean age of 34.2 and constituting 264 (64.4%) females participated. Fifty-one per cent reported to be married/cohabiting, 73.9% lived with their partners and 60.5% were sexually active. The rate of unprotected sex was 69.0% with 12.5% of women reporting to be pregnant at the time of the survey. Further biological children were desired by 37.1% of the participants and lifetime fertility intention was 2.4 children. Increased fertility desire was associated with living and having sex with a partner, HIV disclosure, good perceived health status and CD4 count ≥200 cells for both sexes. Reduced desire was associated with havingmore than 2 children among females, divorce or separation, and having a child with the current partner among both males and females., Conclusion: Fertility desire and intention of PLWHA was substantially high though lower than that of the general population in Tanzania. Practice of unprotected sexual intercourse with higher pregnancy rate was observed. Fertility desire was determined by individual perceived health and socio-family related factors. With increasing ART coverage and subsequent improved quality of life of PLWHA, these findings underscore the importance of integrating reproductive health services in the routine care and treatment of HIV/AIDS worldwide. The results also highlight a group of PLWHA with potentially high desire for children who need to be targeted during care.

Free antiretroviral therapy (ART) has been provided through the public health system in Tanzania since 2004. The success of national ART roll out programme is premised upon collaborative efforts of health systems, communities and policy environment. However, community perceptions of ART and its implications on sexual behaviours and HIV/AIDS prevention remain largely unknown. Drawing on focus group discussions with young people, this paper examines perception about ART and the potential impact of antiretroviral therapy on risk sexual behaviour in rural Tanzania. Participants included a purposively selected sample of males and females aged 14-24 years. Results show that young people were both optimistic and concerned regarding availability of ART. Positive attitudes toward ART were associated with public health significance of therapy in managing opportunistic infections and extending lives of HIV infected persons. However, the positive outcomes of therapy were considered to be short lived, unsustainable and potentially threatening to the sexual health and wellbeing of HIV negative members in the community. ART was considered to empower infected persons to intentionally spread HIV to uninfected individuals in the community through deliberate unprotected sexual activities. The study highlights the significance of reinforcing HIV prevention while underscoring the need to provide appropriate information and increasing access to ART in rural areas of Tanzania. In conclusion, creating a therapy friendly atmosphere through information delivery is crucial in promoting social acceptability of antiretroviral therapy among youths. Efforts to improve access to antiretroviral drugs should re-emphasize prevention counselling to minimize sexual transmission of HIV.