Background: Despite the implementation of anti‑human immunodeficiency virus (HIV) interventions, it has continued to spread from high risk to the low risk population population with the devastating social, economic and health consequences. Aim: The aim of the following study is to identify HIV related knowledge, risk perceptions and practices among married women of reproductive age (MWRA) in Mid‑Western Development Region, Nepal. Subjects and Methods: A community based, cross‑sectional study was conducted during May‑December 2010 among 618 MWRA in Mid‑western Development Region, Nepal. Multistage random sampling was followed wherein four districts, representing each ecological zone were selected in the first stage. Nine Village Developments Committees with the total 81 clusters were selected in the second and third stages. Finally, 7/8 participants/cluster were selected randomly. Household interviews were conducted using pretested structured questionnaire. Data were analyzed by SPSS 16.0 (SPSS Inc. Chicago, IL, USA). Percentages, mean, Chi‑square value and odds ratio were calculated. Results: Nearly three quarters (434/618) of all participants had heard about the HIV. Radio was the most common source of the information 73.3% (318/434) amongst all sources. Unsafe sex 55.3% (240/434), infected blood transfusion 33.2% (144/434), needle sharing 24.7% (107/434) and mother to child transmission 4.1% (18/434) were reported modes of HIV transmission. Condom use during extramarital sex 51.8% (225/434), use of sterilized syringes 24.2% (105/434), restricting sex within couple 22.6% (98/434) and blood safety 20.3% (88/434) were reported HIV preventive measures. Extramarital sex, needle sharing and sharing of the razors/blades were perceived to be the risk behaviors. About 4.9% (30/618) had extramarital sexual experience amongst all participants. Only a quarter (8/30) of those who had extramarital sex used condom regularly. Conclusions: Almost half of the MWRA had limited awareness on HIV transmission and preventive measures. There was poor HIV preventive practices; indicating knowledge‑behavior gaps. Awareness raising and behavior change interventions are recommended.