Abstract: Objective: 1. To determine the prevalence of pre malignant cervical lesions in HIV positive women using conventional Pap smear. 2. To determine the association between various risk factors in HIV positive women and abnormal cytology on Pap smear. Design: A cross-sectional study was conducted in Bangalore Medical College in which eligible HIV positive women underwent Pap smear, human papillomavirus (HPV) testing and cervical biopsy. Methods: Retropositive women attending gynaec OPD during the study period were taken into the study after taking informed consent. Women who fulfilled the inclusion criteria were subjected to Pap smear. Bethesda system of classification was used for reporting the Pap smear. Women with abnormal Pap smear were further evaluated by HPV DNA testing and cervical biopsy. Results: Cervical cytology was abnormal in 30% of the HIV positive women, out of which 10% had HSIL, 15% had LSIL and 5% had ASCUS. Age at first sexual intercourse <17 years (p=0.009), past H/O STI (p=0.0001), women with husband’s having multiple sexual partners (p=0.0001), women with CD4 count < 350 cells/microlitre (p=0.0001) were significant risk factors associated with abnormal Pap Smear. Conclusion: Invasive cervical cancer is considered a preventable disease because of its long preinvasive state. Therefore, screening for pre malignant cervical lesions represents an opportunity to prevent women developing cervical carcinoma.