While the incidence of HIV infection has leveled off in older homosexual men, infection in women, children, and adolescents is rising. Unless effective intervention measures are implemented, the number of pediatric patients with HIV and related illnesses will continue to increase. Interventions aimed at curtailing perinatal transmission potentially will have the greatest impact on decreasing the incidence of pediatric AIDS. Studies evaluating strategies aimed at this are currently underway. Educational initiatives targeting adolescents also may lower the number of pediatric patients with HIV infection. As treatments improve, the majority of HIV-infected children will survive for years and perhaps decades. The number of children with HIV infection in the upcoming decades will have a profound impact on our communities and our practice of pediatric medicine.