Women living with HIV lack evidence-based information about reproductive options while managing pressures from family, clinicians, and communities to give up the idea of having children. As the reproduction intentions of Women living with HIV are not well understood, stigmatizing behaviors force them to hide their disease to avoid rejection by their family, partner, and social networks. Compliance with social norms, fear of stigma, and discrimination influence their experience. The purpose of this study was to synthesize the evidence to explain the reproductive decision-making process for Women living with HIV. A systematic review with research synthesis was conducted through searches in 10 electronic databases (CINAHL, EMBASE, MEDLINE, Scopus, Social Science Citation Index, Web of Science, Google Scholar). Studies published in journals from 2013 to 2023 with data about reproductive decision-making among Women living with HIV were eligible for inclusion. The study authors screened papers for eligibility and included 8 papers in the analysis. Women living with HIV encounter reproductive decision-making with knowledge deficits and limited social support. An integrated approach to holistic care with comprehensive multidisciplinary counseling is needed to support Women living with HIV. Clinicians could benefit from professional development to learn how to be authentically present for Women living with HIV, including engaging in conversations, demonstrating compassion, and understanding situations. Evidence-based clinical practice guidelines need to be tailored for the family planning and sexual health needs of Women living with HIV.