ABSTRACT Background: Anemia is a common manifestation of HIV infection, occurring in approximately 30% of patients with asymptomatic HIV and in as much as 75-80% of those with clinical AIDS (1). Anemia in pregnancy is a major cause of maternal and fetal morbidity and mortality (2). Objective: The aim of this study was to assess the prevalence of anemia and associated factor among HIV positive pregnant women attending antenatal care at Bahir Dar City. Method: Health facility-based cross-sectional study design was carried out from April 2,2024 to June 2, 2024. A total of 201 HIV positive pregnant women were selected by simple random sampling method. Women were interview by using questionnaire and data from registration book and ANC card were reviewed. Data was entered using Epi info version7 and analyzed using SPSS version 23 Bivariable and multivariable logistic regression model was used to see determinants of anemia. All variables were entered into bi-variable logistic regression and variables with p < 0.25 were used to select eligible variables for entry into multivariable logistic regression for analysis. Adjusted odds were used to identify associated factors and p< 0.05 was used to show a statistically significant association with the dependent variable. Results: As the finding shows, a total of 194 study participants were included with the response rate of 91.1%. The prevalence of anemia was 49.5% (95% CI: 46.1, 52.9) Anemia was associated with recent recurrent diarrhea, Iron intake and Duration of Iron Intake (AOR= 2.31, p=0.012), (AOR= 4.25, p=0.022) and (AOR= 5.12, p=0.003), respectively. Conclusion: The prevalence of anemia was high /49.5%./. Anemia was significantly associated with resent recurrent diarrhea, Iron intake and Duration of Iron Intake. These findings emphasize the importance of addressing factors, such as iron supplementation, prevention of Diarrheal disease and intestinal parasites to improve maternal health outcomes among HIV-positive pregnant women. Incorporating routine iron supplementation and addressing conditions like recurrent diarrhea could be integral to comprehensive anemia management programs. Key Words: Prevalence, Associated Factors, Anemia, HIV Positive Pregnant Women, Bahir Dar City