The aim of this study was to identify the factors linked to HIV serostatus and the risks of HIV positivity among children under two years old exposed to HIV at Mityana General Hospital in Mityana district, Uganda. This was a cross-sectional descriptive survey utilizing quantitative data from administered questionnaires and routine service data obtained from the mother’s HIV care card and the exposed infant clinical chart. Data analysis was performed using Epi Info version 7.2.4 for entry and Stata version 16 for analysis. Descriptive statistics characterized both infant and mother traits. Logistic regression was employed to determine the factors associated with HIV serostatus. Among the 102 mother–infant pairs recruited, most mothers were between 25–34 years old (53/102, 52.0%), married (67/102, 65.7%), had attained at least primary education (49/102, 48.1%), and were involved in farming for their livelihood (89/102, 87.3%). The HIV prevalence among the infants stood at 8.8%. In the bivariate analysis, factors such as place of delivery (OR = 4.6, 95% CI: 1.340-9.413, p = 0.003), normal delivery (OR = 4.7, 95% CI:0.682-5.522, p= <0.001), poor adherence to ART (OR=3.11, 95% CI: 0.983-8.344, p=0.026), and the mothers’ level of education (OR=6.2, 95% CI: 3.00-14.476, p= <0.001) were associated with HIV-positive outcomes in infants below two years old. This study underscores that 8.8% of children under 2 years attending Mityana General Hospital are HIV-infected due to exposure from their mothers. Factors contributing to this burden include maternal non-adherence to ART, delivery in facilities lacking PMTCT protocols, maternal education levels, and the absence of prophylaxis administration to exposed infants, collectively propagating HIV transmission among these infants. Keywords: Pediatric HIV, Mother-to-child transmission, HIV serostatus, Infants below 2 years.