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This facility-based cross-sectional study was conducted to determine the patterns of disclosure of HIV positive serostatus among 145 Indian children aged >5 years. Only 60 (41.4%) children were aware of their HIV-positive status. Disclosure was most frequently done by parents [51/60 (85%)] at a mean age of 9.1 ± 1.4 years. The rate of inaccurate disclosure was high [64/85 (75.3%)]. No information regarding their illness was given to 21/85 (24.7%) children. The most common reason for non-disclosure was that the child is too young [79/85 (92.9%)]. The factors favoring disclosure were increasing duration since diagnosis of HIV infection [odds ratio (OR) = 1.46; 95% confidence interval (CI) 1.11–1.93], non-perinatal mode of transmission (OR = 6.14; 95% CI 2.01–15.80), ART initiation (OR = 3.05; 95% CI 1.33–7.01), school enrolment (OR = 3.52; 95% CI 1.44–7.57) and caregiver educated beyond fifth grade (OR = 2.69; 95% CI 1.21–5.96).Detailed guidelines on disclosure are required focusing on children of school-going age with perinatal infection who are not on ART and with caregivers of low educational status.