Globally, the Philippines has one of the fastest-growing rates in increased human immunodeficiency virus (HIV) cases. Mothers and children with perinatally acquired HIV disease (PAHD) have unique special needs that necessitate the development of a counseling framework. As such, this study, based on Straussian grounded theory, sought to explore the needs and experiences of mothers of children with PAHD and construct a counseling framework responsive to their unique context. Utilizing a qualitative research design, this study involved an active interview approach with not only mothers of children with PAHD but also health professionals caring for patients with HIV in the Philippine General Hospital (PGH), a national tertiary university hospital. Individual interviews and focus group discussions were audio-recorded, transcribed, and analyzed using NVIVO, whereas a constant comparative analysis parsed the transcripts. Five thematic processes emerged, namely: (1) reaction of mothers to their own diagnosis, (2) reaction of mothers to their child's diagnosis and condition, (3) stigma, (4) psychosocial care and support, and (5) HIV counseling. Meanwhile, three core categories—call for help, acceptance, and moving on—explain the theory's fundamental structure. Integrating the experiences of the mothers and health professionals and the related literature supporting them, this study developed a counseling framework for HIV counselors supporting mothers of children with PAHD, providing guidance on engaging with mothers with PAHD relative to their milieu, counseling process, guiding principles, and counseling skills.