Emotional distress is most common mental disorder associated with HIV. But little is known in Ethiopia; particularly for the study area where high prevalence of HIV is seen. Comparative cross sectional study employed in 2008 & symptom of emotional distress & their determinants among clients at VCTC prior to testing & counseling & at ART centers prior to initiation of ART assessed. Before the study, ethical clearance obtained from Ethical Committee of Jimma University & data collected using HADS. Of 720 clients, 75%, 55% & 65% respectively were age 18-34, females & literate. 22% were HIV positive from VCTC. Study showed considerable level of distress (34% at VCTC, 46% at ARTC and 67% among HIV positive clients at VCTC) & significant difference in mean score seen; at the ARTC (15.8) Vs VCATC (13.98). However those who became positive at VCTC after the assessment revealed more distress even from ARTC (19.8). Perceived weight loss & partners risk to HIV was predictors in all comparison groups. Multidisciplinary strategies that focus on diagnosis & treatment of emotional distress during counseling & equipping the service with trained staff are so important.