Background: Pregnancy presents unique challenges for HIV-positive women, especially in resource-limited settings. Despite advances in Antiretroviral Therapy (ART), these mothers face increased risks of adverse outcomes, including preterm birth, low birth weight, and perinatal transmission. This study assesses pregnancy outcomes among HIV-positive mothers in Dar es Salaam and compares them to recent findings to evaluate progress and ongoing challenges. Methods: A descriptive cross-sectional study was conducted in the Ilala and Kinondoni municipalities of Dar es Salaam from March 2015 to May 2016. The study recruited 502 postnatal women attending antenatal clinics, including both HIV-positive and HIV-negative mothers. Data were collected using semistructured questionnaires and analyzed in SPSS, focusing on socio-demographic characteristics, healthcare access, and neonatal outcomes. Comparative data from recent studies were reviewed. Results: Of the 502 postnatal women, 9.2% (n=46) were HIV-positive. Most participants were married (78.9%) and had completed primary education (53.4%). Neonatal outcomes included low birth weight (3.4%), preterm delivery (17.5%), low Apgar scores (3.2%), and stillbirths (1.0%), with 25.1% of neonates experiencing adverse outcomes. Socio-demographic disparities were observed, with HIV-positive women reporting different healthcare access levels. Conclusion: Findings highlight the need for targeted healthcare interventions to address ongoing challenges among HIV-positive mothers. Enhanced access to comprehensive prenatal care and strategies to mitigate self-stigma are essential for improving maternal and child health outcomes in this population