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Globally, over 36 million people are living with HIV, and 51% are women, most of whom are of childbearing age. Children of mothers with HIV exhibit more adjustment problems than their demographically similar peers. Using mixed methods, this study examined associations between mothers' HIV stigma and their children's functioning. As part of a multi-site study in Georgia and California, participants included 181 HIV-positive mothers and one of their 6- to 14-year-old children. Mothers reported on children's psychological adjustment, their own anxiety, and their perceived HIV stigma. Children reported on parent-child relationship quality. Following the quantitative portion of the study, 14 mothers and 13 children who knew their mothers were HIV positive completed in-depth qualitative interviews addressing the impact of HIV disclosure on family relationships. Hierarchical regression analyses found that parent-child relationship quality, maternal anxiety, and HIV stigma were significantly associated with child adjustment difficulties. HIV stigma predicted child adjustment problems after accounting for the role of parent-child relationship and maternal anxiety. Most mothers and some children in the qualitative portion of the study discussed the impact HIV stigma on their lives. In all, despite efforts to decrease HIV stigma, it continues to affect the lives of those with the virus and their families. Interventions, then, should not only focus on the parent-child relationship and maternal anxiety when attending to child functioning in families affected by HIV, but should also target coping skills for mitigating the impact of stigma while continuing efforts to reduce HIV-related stigma. Highlights: Maternal HIV stigma is significantly associated with child adjustment difficulties. HIV stigma persists as a significant concern for families affected by maternal HIV. Qualitative reports of HIV stigma are consistent with ones from over 15 years ago. [ABSTRACT FROM AUTHOR]

Mothers living with HIV (MLH) face unique stressors impacting parenting, parenting stress, and child psychosocial functioning, but longitudinal, bidirectional relations among family processes have not been examined in this population. This study examined relations among parenting quality, parenting stress, and child functioning in 174 MLH-child dyads (aged 6–14, Mage = 9.65, SD = 2.49; 51% female; 57% Black/African American; 35% Latinx). Families completed self-report questionnaires over four waves spanning 15 months. Cross-lagged panel analysis revealed unidirectional and bidirectional relations between parenting stress and child functioning; parenting quality and child functioning; and parenting quality and parenting stress. The findings suggest that prevention and intervention efforts with HIV-affected families should target both parent factors (e.g., communication skills) and child factors (e.g., emotion regulation), emphasizing parenting stress reduction in order to bolster family outcomes. [ABSTRACT FROM AUTHOR]

Maternal illness is a stressor that can disrupt family processes and contribute to negative child outcomes, and researchers have considered family variables that mediate or moderate the maternal illness–child outcome relationship. Through reliance on a diverse sample (ethnically and racially, as well as geographically), the current study expands prior literature with a focus on parent–child conflict. Specifically, associations between aspects of HIV positive mothers' illness and mother–child conflict were explored. One goal of the study was to determine if there were direct or indirect associations with aspects of mothers' HIV and mother–child conflict. HIV-positive mothers (N = 136) provided CD4 count and completed measures assessing their perceived level of physical functioning, depressive symptoms, HIV health-related anxiety, and mother–child conflict with their healthy school-age children. Path analysis considered the pattern of relationships across variables. Results showed maternal vitality and depressive symptoms were directly associated with mother–child conflict. CD4 cell count and health-related anxiety operated indirectly through maternal depressive symptoms. Mediation analyses further assessed the influence of maternal CD4 cell count on mother–child conflict behavior; results indicated an indirect effect was mediated by vitality. HIV health-related anxiety and vitality separately showed indirect effects on mother–child conflict, mediated by maternal depressive symptoms. These findings are the first to focus on mother–child conflict among children affected by maternal HIV and highlight the need for screening and intervention to address depressive symptoms among HIV-positive mothers. [ABSTRACT FROM AUTHOR]

Nondisclosure of maternal HIV status to young children can negatively impact child functioning; however, many mothers do not disclose due to lack of self-efficacy for the disclosure process. This study examines demographic variations in disclosure self-efficacy, regardless of intention to disclose, and assesses the relationship between self-efficacy and child adjustment via the parent-child relationship among a sample of HIV+ mothers and their healthy children (N = 181 pairs). Mothers completed demographic and self-efficacy measures; children completed measures assessing the parent-child relationship and child adjustment (i.e., worry, self-concept, depression). Across demographics, few mothers reported confidence in disclosure. Results from covariance structural modeling showed mothers endorsing higher self-efficacy had children who reported better relationship quality, and, in turn, reported fewer adjustment difficulties; higher levels of disclosure self-efficacy also directly predicted fewer adjustment problems. Findings offer support for interventions aimed at providing mothers with skills to enhance confidence for disclosing their HIV status. [ABSTRACT FROM AUTHOR]

Dental problems are among the most frequently reported health issues of drug users. This study describes, among the largest population of methamphetamine (MA) users to date (N = 459, including both HIV-negative and HIV-positive participants) oral hygiene practice, dental care access, and dental quality of life. A matched control group from the Third National Health and Nutrition Examination Survey was utilized. Findings conclusively establish that MA users have severe oral health deficits compared to the general population: they are 3.5 times more likely to experience painful toothaches, 6.6 times to experience difficulty eating, and 8.6 times to be self-conscious due to dental appearance. HIV-positive users were more likely to have regular dental visits than HIV-negative users. Severity of use (both high-frequency use as well as injection as the method) was associated with poorer oral health care. Despite the magnitude of the need, few MA users receive the needed care. [ABSTRACT FROM AUTHOR]

In this study we explore associations between child and adult victimization and sexual risk behavior in 118 young, HIV positive women. Prior research has demonstrated associations between victimization and engagement in sexual risk behavior. Victimization sequelae can include disrupted assertiveness and communication, as well as increased association with risky partners, both of which are also linked with engagement in sexual risk behavior. Thus, we propose a model wherein victimization is linked to sexual risk behavior through two mediating pathways, sexual communication and affiliation with risky partners. We also examine the moderating effects of the presence of an anxiety or depressive disorder on the path from child to adult victimization. Results suggested that adult victimization was associated with unprotected sex with a main partner; however, this association was mediated by less sexual communication and having a risky partner. Trends toward significance were found for depression and anxiety as a moderator of the relationship between child and adult victimization. Child victimization did not have direct effects on unprotected sex. Implications for secondary prevention of HIV and healthy intimate relationships are discussed. [ABSTRACT FROM AUTHOR]

We used discrete-time survival mixture modeling to examine 5,305 adolescents from the 1997 National Longitudinal Survey of Youth regarding the impact of parental monitoring during early adolescence (ages 14-16) on initiation of sexual intercourse and problem behavior engagement (ages 14-23). Four distinctive parental-monitoring groups were identified and labeled as 'High,' 'Increasing,' 'Decreasing,' and 'Low'. About 68% of adolescents received a high level of parental monitoring from ages 14 to 16 (High), 6 and 9% respectively exhibited an accelerated (Increasing) and a decelerated trajectory (Decreasing), and 17% had consistently low parental monitoring (Low). Relative to participants in the Low group, adolescents in the High group delayed sexual initiation by 1.5 years. Males, relative to females, were more likely to have had a low trajectory of parental monitoring, and were more likely to initiate sexual intercourse before age 14. In contrast to White Adolescents, Hispanics and Blacks were less likely to receive High parental monitoring, and had a higher rate of early sexual initiation before age 14. The study demonstrates the temporal relationship of parental monitoring with adolescent sexual initiation from a longitudinal perspective. An increase of parental monitoring across ages is accompanied with a decrease of sexual risk. The continual high level of parental monitoring from ages 14 to 16 also mitigated the risk of engagement in substance use and delinquent behaviors from ages 14 to 23. [ABSTRACT FROM AUTHOR]

djusting to chronic illness is very complicated for families with children, as they are already faced with the challenge of development and childrearing. In this study, qualitative interviews were conducted with HIV positive mothers on a number of issues related to being an HIV positive mother raising young children. One topic of the interview was whether or not they felt that HIV had caused them to miss activities with their children while the children were growing up, what types of activities they had missed, the age of the child for each example, and how HIV had led to missing these activities. Interviews were conducted in 2008 with a random sample of 57 mothers being followed in a longitudinal assessment study. All study participants were English or Spanish speaking. Mean age was 44.1 (SD = 5.6) years; 47% were Latina; 35% African American; 11% White; and 7% other race. About 60% of the mothers disclosed that their HIV status had caused them to miss out on activities with their children while their children were growing up, ranging from daily care activities to major school and extra-curricular activities. Some mothers missed significant amounts of time with their children due to hospitalizations. In some cases mothers felt forced into a choice between mothering ability and their own health, including adherence to medications. Implications for the mothers and the children are discussed. [ABSTRACT FROM AUTHOR]

We interviewed 33 HIV-infected parents from the HIV Cost and Services Utilization Study (HCSUS), 27 of their minor children, 19 adult children, and 15 caregivers about the process of children learning that their parents were HIV positive. We summarize the retrospective descriptions of parents' disclosure of their HIV status to their children, from the perspective of multiple family members. We analyzed transcripts of these interviews with systematic qualitative methods. Both parents and children reported unplanned disclosure experiences with positive and negative outcomes. Parents sometimes reported that disclosure was not as negative as they feared. However, within-household analysis showed disagreement between parents and children from the same household regarding disclosure outcomes. These findings suggest that disclosure should be addressed within a family context to facilitate communication and children's coping. Parents should consider negative and positive outcomes, unplanned disclosure and children's capacity to adapt after disclosure when deciding whether to disclose. [ABSTRACT FROM AUTHOR]

The utilization of administrative data in substance abuse research has become more widespread than ever. This selective review synthesizes recent extant research from 31 articles to consider what has been learned from using administrative data to conduct longitudinal substance abuse research in four overlapping areas: (1) service access and utilization, (2) underrepresented populations, (3) treatment outcomes, and (4) cost analysis. Despite several notable limitations, administrative data contribute valuable information, particularly in the investigation of service system interactions and outcomes among substance abusers as they unfold and influence each other over the long term. This critical assessment of the advantages and disadvantages of using existing administrative data within a longitudinal framework should stimulate innovative thinking regarding future applications of administrative data for longitudinal substance abuse research purposes. [ABSTRACT FROM AUTHOR]

This study utilized data from the National Longitudinal Survey of Youth to investigate youth risk trajectories for HIV and factors associated with different trajectories. The sample ( N = 8,208) was 49.2% female, with a mean age of 14.31 ( SD = 1.48). A group-based trajectory model was applied, which identified four distinct trajectories for both males and females: (1) consistently higher sexual risk levels, increasing to early adulthood followed by some decrease (“high”); (2) a short period of increase to late teens, followed by a longer period of decrease (“decreased”); (3) an initially slow increase, with the increase accelerating by late teens, and a slight decline beginning in early adulthood (“increased”); and (4) consistently lowest levels of sexual risk (“low”). More African Americans were found among the decreased trajectory group; among the low risk group a higher number of youth came from families with parents who spoke a language other than English. The high-risk group had a higher percentage of subjects in non-metropolitan areas and highest alcohol use. Among males, being employed and being in the military were associated with inclusion in the high-risk group. Results have implications for specializing prevention strategies for youth with different patterns of sexual risk. [ABSTRACT FROM AUTHOR]

This study tested components of the acquired immunodeficiency syndrome (AIDS) Risk Reduction Model (ARRM) for a sample of methamphetamine-using offenders in drug treatment. Analyses included the first two stages of the ARRM, problem recognition and intention to reduce risk (potential precursors to later possible behavior change), assessing predictors of intentions to increase condom use, reduce other sexual risk, and disinfect needles. Path analysis results showed potential applicability of the ARRM as a basis for intervention development for this population. There was a consistent effect of self-efficacy for risk reduction strategies, as well as direct or indirect effects of problem recognition factors (AIDS knowledge, peer norms), on the three intention indicators. Prior sex risk behavior (condom use) was directly negatively related to intention to use condoms; prior needle use was indirectly negatively related to intention to disinfect. Intention to use condoms was lower for women. Results can help identify areas for intervention development. [ABSTRACT FROM AUTHOR]

Little is known about the impact of maternal disclosure of HIV-positive serostatus on young children. The objective of this study was to explore this topic, utilizing in-depth qualitative interviews. Qualitative interviews were conducted with 47 mothers who had disclosed to their young, well child, and with the children. The most prevalent child response was anxiety, primarily focused on the mother's health and fear of her death. A number of children also worried about other people finding out, and seemed aware of the stigma surrounding HIV. For most children anxiety decreased over time, although for a small number it sustained and became maladaptive. The majority of children appeared to adjust well to maternal disclosure. Mothers who are planning to disclose their serostatus to their young children should be encouraged to plan for appropriate psychosocial follow-up following the disclosure, with special focus on the stigma associated with HIV. [ABSTRACT FROM AUTHOR]

Qualitative interviews were conducted with mothers (N = 47) who had disclosed their HIV status to their child. Mothers described their preparation and the process of the disclosure event, and discussed any regrets they had about disclosing or the process of disclosing. They were also asked what advice they had for other HIV-positive mothers who were trying to determine whether to disclose their serostatus to their young children. Overall, the majority of the mothers (68%) did not regret disclosing their HIV status. Regrets fell into five categories: preparation, timing, context, content, and outcomes of the disclosure event. Based on these findings, mothers who have not disclosed their serostatus to their children need assistance with behavioral practice and support in order to prepare for the process. Furthermore, follow-up support for the children may be beneficial. [ABSTRACT FROM AUTHOR]

Qualitative interviews were conducted with mothers (N = 47) who had disclosed their HIV status to their children. The majority of mothers explicitly told their child not to disclose to other people that she was HIV-positive because they feared repercussions in the way of stigma and ostracism for both themselves and their child. Approximately one-fourth of the mothers identified “safe people,” to whom their child could discuss her serostatus, such as family members, health care providers, or therapists. The majority of the children respected their mothers' wishes; only four children disclosed to someone after being explicitly told not to do so. A significant number of children expressed concerns about their friends finding out, fearing that they would be ostracized or that it would be assumed they were also infected. In addition, the children did not want others to find out because they wanted to protect their mothers. The burden of keeping the secret of their mothers' serostatus does seem to be a stressor for some of the children. [ABSTRACT FROM AUTHOR]

Assessing anxiety and depressive symptoms through direct interviewing of young children has been found to be particularly difficult utilizing standard interview methods. Test–retest reliability of selected anxiety and depression items from the revised Dominic (Valla, Bergeron, Bidaut-Russell, St-Georges, & Gaudet, 1997), a cartoon-based questionnaire based on DSM diagnostic criteria, was investigated among two geographically diverse samples (Los Angeles and St. Louis; N = 37). Overall, kappas were higher for the anxiety items than for the depression items. In both cities the sample included clinic and non-clinic cases of African-American, Hispanic/Latino, and Caucasian children age 6–8; kappas for the anxiety and depression items were higher among the clinic cases than for the community cases. Given the need for psychometrically sound measures for culturally diverse samples of children, this initial report suggests that the use of selected Dominic items holds promise as a cartoon-based assessment of young children. [ABSTRACT FROM AUTHOR]

Health behaviors and mental health symptoms of parents living with AIDS (PLAs) were examined as a function of their sexual and substance-use lifestyles. The lifestyles of PLAs were classified as (1) Safe and Clean: having only protected sex and abstaining from substance use, (2) Safe Users: having protected sex, but engaging in substance use, (3) Unsafe and Clean: having unprotected sex, but abstaining from substance use, and (4) Unsafe Users: having unprotected sex and engaging in substance use. About half of the PLAs were Safe and Clean. Unsafe Users were more likely to miss doctor appointments and to have been diagnosed longer. Safe and Clean PLAs experienced fewer major life events. Changes in specific daily routines were associated with subgroup status; however, there were no consistent patterns across health behaviors linked with lifestyle. These data suggest there are different types of lifestyle changes made by PLAs when they know their serostatus. A disturbing number of PLAs continue to engage in HIV-transmission risk behaviors, demonstrating the need for preventive interventions. [ABSTRACT FROM AUTHOR]

Studies substance use and its relationship to depression, anxiety and isolation among United States youth living with HIV. Social networks; Emotional distress and risk behaviors.

Although AIDS rates have leveled among older gay men in large original epicenters, HIV seroincidence remains high among young men who have sex with men (MSM) in many areas of the country. This research examined patterns of risk behavior among young (age 25 years or less) and older (age 26 years and over) MSM. Nearly 2,000 men entering gay bars in 16 small U.S. cities completed an anonymous survey of their sexual practices in the past 2 months and of psychosocial risk-related characteristics. Young men were more likely than older men to have engaged in unprotected anal intercourse and, specifically, receptive intercourse in the past 2 months. Younger men also reported more frequent occurrences of unprotected anal intercourse. A progressive decline in risk behavior levels was associated with increasing age. Young men less often personally knew someone who had died of AIDS, and deaths were not primarily within their close social networks. Continued HIV prevention efforts directed toward young MSM are needed, including cities traditionally considered as second tier with respect to AIDS. [ABSTRACT FROM AUTHOR]

Conceptual formulations of HIV risk reduction and many HIV prevention interventions reported in the literature emphasize the role of sexual assertiveness, negotiation, and communication skills as key elements for enacting behavior change. However, there have been few attempts to determine if objective ratings of individuals' sexual communication skill effectiveness are actually associated with their levels of HIV sexual risk behavior. In the current study, 114 severely mentally ill men and women role-played scenes in which confederates simulated attempts to coerce unprotected sex. Participants' role-played responses were transcribed verbatim and later rated for quality in several areas of assertiveness skill effectiveness. In addition, participants provided detailed information concerning their sexual behavior practices in the past 30 days. Participants were categorized into highly, intermediately, or poorly skilled groups based on effectiveness in role play performance, and the groups were then compared on indices of HIV risk behavior. Individuals with high objectively rated sexual assertiveness skill had the lowest number of unprotected sex acts, the smallest number of different sexual partners, the smallest number of casual sex partners, and the highest levels of condom-protected sex in the past 30 days. Individuals with poor sexual assertiveness role-play skills had the highest levels of sexual risk behavior. These associations were especially pronounced among women. Findings of this research provide support for teaching individuals to develop and refine their sexual assertiveness and communication skills in HIV prevention programs. Future research issues in this area are highlighted. [ABSTRACT FROM AUTHOR]

Brief screening procedures are needed that identify persons at risk for HIV among high-risk groups, in order to begin preparing for future HIV/AIDS vaccine trials. The sensitivity and specificity of brief screening procedures were evaluated among 481 African-American and Latina women (both English- and Spanish-speaking) and 143 gay men to identify people at risk for HIV who may benefit from participation in an HIV/AIDS vaccine trial. There were significant ethnic and population differences in sensitivity and specificity. Overall, the brief screening instrument has a sensitivity rate of 94.8% and specificity rate of 88.6%; these rates are significantly better than earlier screening procedures employed to assess risk acts. [ABSTRACT FROM AUTHOR]

The level and consistency of HIV-related sexual and substance-use risk acts, health status, and medical adherence were examined among 102 HIV+ youths aged 14 to 23 years (27% African American, 33% Latino). Over their lifetime, youths engaged in unprotected sexual acts with multiple partners ( M = 284; Median = 44; consistent condom protection, 5%) and substance use (21% injecting drug use; 68% hard drugs). When current risk behaviors were assessed twice over two consecutive 3-month periods, almost one third had been sexually abstinent. Among youths who were currently sexually active, most had multiple sexual partners ( M = 5.7, Time 1; 4.9, Time 2) and used condoms (72-77% sexual acts protected); most of the youths (63-64%) always used condoms. Use of alcohol (63%), marijuana (41%), hard drugs (36%), and injecting drugs (12%) was substantial. Youths were relatively healthy ( M T cells = 521.4; 14% T cells < 200; 1.9 diseases and 3.7 physical symptoms in the previous 3 months); they attended about one third of their medical appointments. While all youths were linked to adolescent HIV programs, unhealthy behavior and risk acts remained common. More effective and intensive intervention appears required. [ABSTRACT FROM AUTHOR]