The rationale of this qualitative study was to determine how a positive HIV diagnosis influenced fertility desires and reproductive decisions for women and men living in western Uganda and what the reasons were behind these fertility desires. The qualitative study was undertaken as part of a larger study on the same topic in order to better understand the quantitative findings. Five focus groups with a total of 35 participants, 20 women and 15 men were conducted. Eighteen participants were HIV positive. Almost all HIV-positive participants reported that they did not wish to have more children. The most important reasons given were the devastating impact of HIV on the health of the mother and the high risk of HIV transmission to the child. Most participants were not aware of the benefits of highly active antiretroviral therapy on reducing the risk of mother-to-child transmission of HIV. Some HIV-negative participants viewed ongoing childbearing by HIV-positive individuals as the result of a lack of education regarding the risks of childbearing while HIV-positive and also as contrary to the current expectations of lifestyle practice. They also emphasized that the community’s perceptions of having children when mothers are HIV-infected was unfavorable and that fertility norms for all persons in the study area have now changed due to economic concerns and desire to educate all children in the family. The study findings have to be incorporated in the counselling curriculum for programs directed at HIV prevention and care and family planning. Specific recommendations are provided to improve the districts’ primary healthcare programs for HIV care/prevention and family planning.