Despite the development of highly effective treatments for the disease, pediatric human immunodeficiency virus (HIV) infection continues to affect a substantial number of families both in the United States and worldwide. This article reviews the psychosocial functioning of children with HIV, taking a socioecological perspective to organize the literature. When compared to children from similar socioeconomic situations, children with HIV demonstrate a range of possible outcomes. However, beyond the direct effects on children's neurocognitive and psychological functioning, HIV infection may disrupt many of the social support systems that children depend on for optimal development. Further, unlike many other illnesses, children with HIV infection are more likely to experience parental illness and possible death, social stigmatization, and the prospect of lifelong adherence to complicated medical regimens. Families face difficult decisions regarding disclosure of the illness both to the child and to others within and outside of the family. Children who are disclosed to about their illness generally evidence better adjustment. Similarly, appropriate disclosure outside of the immediate family may confer some benefits to the child in terms of psychological and physical health. However, research into the larger social ecologies of youth with HIV remains lacking, limiting the conclusions that can be drawn regarding longer term outcomes.