Background: The practice of breastfeeding for HIV positive mothers is a highly challenged and controversial global public health concern. The risk of mother to child transmission of HIV through breastfeeding is not been adequately examined, and there is some confusion regarding the recommendation and guidelines of infant feeding options. A prior study conducted in this issue is done on different urban setting. Therefore, this study aims to fill this gap and encourage policy makers and relevant program areas for proper planning and intervention in the study area. And also, assess current recommendation and other types of infant feeding practices among HIV positive mothers during the first six months and its determinant all in rural and urban settings. Objective: To assess the exclusive breastfeeding practice and associated factors among HIV Positive mothers attending ART/PMTCT clinic in governmental health institutions Bahir dar town. Methods: A health facility based cross sectional study was conducted among HIV/AIDs positive mothers selected by a Systematic random sampling method, who have infants 6-12 month attending at eight ART/PMTCT clinics in Bahir dar town. The data was entered to EPI info version 3.5.1 and analyzed using SPSS version 20.0 statistical software. Independent variables with P-value less than 0.2 in the bi variant analysis were included in the multivariable logistic regression model to identify factors associated with EBF. Result: Among 340 HIV positive 88.20% mothers had exclusive breast-feeding practices and (92%) of the participant have good knowledge on exclusive breast feeding for their children at 6-12 months. Income of the respondent (AOR=3.4, 95% CI (1.2,9.6), mother who have a health workers influences (AOR,3.7,95% CI,(1.3,10.7), mother who had ANC follow up (AOR,6.4,95% CI (1.8-23),mother who practices normal delivery (AOR=4.1, 95% CI (1.6, 10) and knowledge of mothers on breast feeding (AOR=4, 95% CI (1.4,11.6) were among the predictive variable which had a significant association with exclusive breast feeding practices. Conclusion and Recommendation: This study revealed that large proportion of HIV positive mothers had followed the recommended infant feeding practice. Therefore, the health workers should educate mothers about exclusive breast feeding, increasing ANC utilization, and counseling mothers to deliver in normal mode of delivery facilitates EBF practice. Income of the respondent, mother who have a health workers influences, mother who had ANC follow up mother who practices normal delivery, and knowledge of mothers on breast feeding were among the factors that have an effect on exclusive breast feeding practices.