Despite the increased emphasis on antiretroviral therapy (ART) and other health care services for HIV-infected individuals in sub-Saharan Africa, issues of fertility and childbearing have received relatively little attention. In particular, little is known about the prevalence and determinants of fertility intentions among HIV-infected women and men who are receiving ART. We conducted a cross-sectional study from August to November 2005 investigating these issues among patients attending a public sector ART service who had been receiving ART for at least one month. Overall, 311 individuals were interviewed (median age, 33 years) and 29% (n = 89) stated that they wanted to have children in the future. This proportion was slightly higher among males than females (36% versus 26%, p = 0.09). In a multivariate model predicting fertility desire among all participants, fertility desire was associated with male gender (odds ratio (OR):2.58; 95% confidence interval [CI]:1.29-5.08), younger age (OR: 0.92; 95% CI: 0.87-0.97), decreased number of children (OR: 0.32; 95% CI: 0.15-0.69), and being in a relationship of less than 5 years (OR: 3.93; 95% CI: 1.91-8.08). In addition, fertility desire was associated with increasing duration of ART among female participants, but not among males. These results suggest that a substantial proportion of HIV-infected women and men receiving ART in this setting would like to have children in the future. This highlights the importance of incorporating fertility-related counseling, as well as contraception and advice regarding safe conception and childbirth, as appropriate, into HIV treatment services. These findings also suggest that fertility desires may change through time and thus require ongoing attention as part of long-term care.