The sexual and reproductive health (SRH)-related needs of people living with HIV/AIDS (PLHA) have not been sufficiently recognised in research and clinical care. Fifteen study sites in 13 European countries participated in this qualitative study to assess differences in perceptions between service providers (SP) and PLHA on SRH-related problems and needs of PLHA. Factors influencing SRH were determined to collect evidence on how to improve service provision. Qualitative data were obtained using an interpretative ethnographical approach. Data were analysed inductively on country level; a cross country data matrix was developed to facilitate the contextual analysis. Thirty-seven FGD discussions were organised with a total of 254 participants. A short survey was distributed to assess demographic characteristics. Results revealed insufficient information and lack of behavioural skills regarding SRH issues among PLHA. Intra- and interpersonal, provider-related, and social factors were found to influence the SRH behaviours of PLHA. Although from patients' perception SRH is a prioritized issue, it rarely comes up during routine HIV clinical care. SP need adequate counseling training to tackle SRH-related issues. A better integration between HIV care programs and SRH care settings is needed to improve effective service provision.