Background: HIV/AIDS is known to be one of the most catastrophic diseases that have confronted humanity in living memory. Even though there are segments of disadvantaged social groups who are at risk HIV infection due to their lower level of socio economic capacity it is believed that people with disability are more vulnerable to HIV infection. Objective: To assess the risky sexual practices, accessibility and utilization of HIV service among people with disability in Addis Ababa City Administration. Materials and methods: Between September 2010 and April 2011, a cross sectional community based survey was conducted using interviewer administered questionnaire of 417 people with disabilities found from associations of people with disabilities in Addis Ababa City Administration. This was supplemented with focus group discussions with disabilities for access and utilization of HIV services. The findings were described and analyzed using SPSS version 16. Result: Based on the findings, more than half (60%) of study participants were sexually active and a third of them (28.4%) had initiated sex before 18 years. Almost half (48%) of these did not use condoms consistently and 33.6% had multiple sexual partners. Majority (92.8%) have information for existence of HIV services in the country. About 72% of all participants have ever utilized some kind of HIV services ever. Female respondents were nearly 2.5 times more likely to use condoms than males irrespective of type of disabilities [AOR (95%CI) 2.46 (1.28-4.71)]. Those ever married were 2.5 times more likely to use condoms than singles [AOR (95%CI) 2.54(1.49-4.35)]. Visually impaired participants are about 2 times more likely to have multiple sexual partners than those of physically impaired [AOR (95%CI) 1.90(1.02-3.55)]. In addition, those who were singles are 45% less likely to have multiple sexual partners than those of ever married [AOR (95%CI) 0.55(0.31- 0.97)]. Regarding utilization of HIV services, hearing impaired participants were about two times more likely to have utilized any HIV services than those of visual impaired [AOR (95%CI) 2.12(1.13-3.98)]. Conclusions: In general, the findings in this study showed poor access to information, less convenient of facilities and low utilization of HIV service among people with disabilities. Improving access to information on HIV through targeting PWDs, support to HIV service providers in developing disability sensitive communication materials and improving health service delivery systems to take care of disability are recommended