Background : It has not been known whether the formerly secluded Batwa py gmies of Kanungu district, S. western Uganda have equal utilization of the a vailable HIV care services and if their integration into the surrounding Bantu population increased thei r vulnerability to HIV infection. Goal: To determine the level of HIV care service utilization a nd the vulnerabilities among the Batwa people to HIV infection in order to inform specific health and health education interventions. Methods: 24,195 Cross-sectional survey responses to questions about knowle dge of where to test for HIV, ever tested, and where to get ART, including 7,053 H IV test results for 12 months ending June 2009 from sub counties of Kayonza and Mpungu where Batwa set tlements are located in Kanungu district were analyzed. Knowledge and utilization of HIV care services were compared between Batwa and non-Batwa using logistic regression analyses to test for differen ces between the two groups for HIV diagnoses, knowledge and utilization of HIV care services. Results: 61% of the Batwa and 59% non Batwa knew where to test from. More Batwa ( 47.5% ) had tested for HIV in the past 1 year than non Ba twa (36%), p-value; <0.001. 55.8% Batwa and 52% non-Batwa knew where to get ART. HIV diagno ses were generally found to be 3.8% (270/7,088), although it was lower among the Batwa, 2.2% (5/223) than non batwa, 3.9% (265/6865), OR, 0.60, 95%CI (0.24-1.47), P-value 0.263. Conclusions/Recommendations : Batwa pygmies were more aware of HIV care services in t he area and had utilized the services more than the non-Bat wa (Bakiga), had less HIV diagnoses and were 40% less likely to be HIV infected than the non Batwa. HIV awareness and VCT services need more emphasis among men and teenagers