MLH and their children
MLH were predominantly Latino (71%) or African-American (23%), 39 years of age, and had three children (). Typically, one child’s age was eligible for enrollment (64%; range 1–4). Almost two-thirds of MLH had less than a high school education and most were struggling to survive economically. Only one-third were employed and about half had health insurance.
MLH reported few HIV-transmission acts at baseline: 21% only had one sexual partner during their lifetime. Only 53% were currently sexually active, 20% had unprotected sex with sero-discordant partners, 27% used alcohol, and 19% used hard drugs.
The school-age children of MLH were 15 years old on average; 83% were in school, 17% were employed, and 29% had experienced sexual debut. Adolescents reported few problem behaviors: only 11% reported more than one problem act. On average, adolescents reported fewer mental health symptoms than normative samples of same-age peers at baseline; all comparisons were significantly different (t = −2.08 to −8.09, df = 878 for girls and 1646 for boys, all P< .05) except for female depression (t = −1.90, df = 878, P = 0.06) and anxiety (t = −1.39, df = 878, P = 0.16). Nine percent reported clinically significant internalizing or externalizing symptoms. Among the 40% who had been tested for HIV, 10% were HIV-positive.
Comparison of MLH and NCM at baseline
As shown in , MLH and NCM were similar in age, their number of children, and having health insurance. However, there were a few important differences between the two conditions. Compared to MLH, NCM were less likely to be Latino, reported higher socioeconomic status, were more likely to have a high school diploma or its equivalent and to be employed (all p<0.05). NCM were also more likely to have a romantic partner and to be married, but more likely to engage in risky sexual behavior compared to MLH (all p<0.05). In addition to what is presented in at baseline, MLH not living with a partner were more likely to report “struggling to survive” versus “barely paying bills, having the necessities, or being comfortable” versus MLH living with a partner (32% vs. 10%; Chi-square = 10.51, df = 1, p < .01). This difference was not significant among NCM without and with a partner (21% versus 19%). Recent hard drug use was lower among NCM compared to MLH (7.5% vs. 19%; p<0.01).
Adolescents of NCM and MLH were similar in mean age, ethnicity, gender, employment, multiple problem behaviors, school enrollment, attendance, and grade level (), as well as numbers of CBCL internalizing and externalizing symptoms ().
Characteristics of Adolescents of Mothers Living with HIV (MLH) and Neighborhood Control Mothers (NCM) at Recruitment.
The frequency of parent-child role reversal, appropriate expectations, and empathy were similar on the AAPI across groups. MLH reported lower initial levels of conflict reasoning than NCM (; t = −3.08, df = 212, p< 0.01) and less physical violence compared to NCM (t = −2.13, df = 212, p<0.01), but were similar on verbal aggression. At baseline, MLH self-reported higher levels of cohesion and expressiveness on family measures, more social interactions, a more democratic style of parenting, and a higher internal locus of control (t = 4.25 to 8.45, df = 522 to 533, all p< 0.01). MLH reported less conflict compared to NCM (t = −4.14, df = 532, p<0.01). At baseline, MLH’s style of parenting was to remain significantly more engaged during conflict, rather than the disengagement style of NCM (t = 4.02, df = 533, p<0.01).
Plots of Estimated Means over 18 months for Mothers Living with HIV (•) and Neighborhood Control Mothers (ο).
Compared to NCM over time, MLH reported higher levels of conflict reasoning (; t = 2.56, df = 212, p=0.01) and lower levels of physical violence (t = −4.21, df = 212, p<0.01); verbal aggression was similar. Compared to the NCM, family cohesion of MLH decreased over 12 months, but then increased for 6 months (; linear est. = −0.22, t = −6.93; quadratic est. = 0.0088, t = 5.40, df = 531, both p<0.01). Similar patterns were seen for expressiveness (linear est. = −0.19, t = −7.04; quadratic est. = 0.0070, t = 5.03, df = 531, both p<0.01), an internal locus of control (linear est. = −0.12, t = −4.65; quadratic est. = 0.0043, t = 3.06, df = 522, both p<0.01), and a democratic style (linear est. = −0.17, t = −5.85; quadratic est. = 0.0070, t = 4.73, df = 530, both p<0.01). A mirror image of the outcome trajectories is seen for laissez-faire parenting (). Compared to NCM, the MLH increased in laissez-faire parenting until 12 months (linear est. = 0.13, t = 4.70, df = 527, p < 0.01), and decreased in laissez-faire parenting thereafter (quadratic est. = −0.0054, t = −3.76, df = 527, p < 0.001). MLH reported higher levels of conflict (t = 3.16, df = 532, p<0.01) and lower levels of both social interactions (t = −2.47, df = 533, p =0.01) and engagement (t = −2.83, df = 532, p<0.01) over time (not shown). NCM reported significantly fewer mental health symptoms on the logarithmic scale at baseline (all p<0.01); however, symptoms of MLH decreased significantly more over time (t = −4.82 to t = −4.42, df = 549, all p<0.01 for global distress, anxiety, and depression). Log-transformed global distress is shown in .
Youth Over Time
Estimated outcome trajectories are shown for several key outcomes in . MLH’s children reported higher overall levels of CBCL internalizing symptoms across time compared to NCM youth (t = 2.11, df = 197, p = .04); MLH and NCM youth did not significantly differ on externalizing symptoms. Reports of CBCL internalizing and externalizing symptoms as reported by mothers did not differ between MLH and NCM. Global distress, anxiety, and depression were similar between MLH and NCM youth. MLH’s children initially increased, then decreased the likelihood of having unprotected sex over time compared to NCM’s children (linear est. = .23, t = 2.20; quadratic est. = −0.011, t = −2.12, df = 689, both p = 0.03). Among marijuana users, MLH youth decreased their frequency of use over time compared to NCM youth (t = −5.41, df = 292, p<0.01). Among hard drug users, MLH’s children increased the frequency of hard drug use over time compared to NCM’s children (t = 2.56, df = 292, p = 0.01). At 18 months, the school drop-out rate was similarly low at 4% across MLH and NCM youth.
Plots of Estimated Means over 18 months for Adolescents by Mothers Living with HIV (•) and Neighborhood Control Mothers (ο).