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1.  Self-competence Among Early and Middle Adolescents Affected by Maternal HIV/AIDS 
Adolescent children of mothers with HIV face a host of stressors that place them at increased risk for poor outcomes. Using covariance structure analysis, this study examines adolescent risk outcomes and their relationships to maternal health, as well as the potentially protective factors of family environment and self-competence. The final model indicated that poor maternal health was negatively related to a protective family environment, which in turn was negatively related to adolescent risk outcomes. A protective family environment was also positively related to adolescent self-competence, which was negatively related to adolescent risk outcomes. Implications of the study are discussed, including how these findings can influence interventions aimed at reducing the risk for poor outcomes among adolescent youth with HIV-infected mothers.
PMCID: PMC3319103  PMID: 22485061
Maternal HIV; Adolescent Risk Outcomes; Family Environment; Self-competence
2.  Effects of Maternal HIV on Children’s Psychosocial Adjustment with Peers and with Their Mother 
A longitudinal assessment was undertaken of young adolescents’ psychosocial outcomes affected by maternal HIV/AIDS, focusing on both parent-child psychosocial ties and peer relationships. Data were taken from the Parents and Children Coping Together study (PACT), a 15-year study assessing mothers with HIV/AIDS and their well children every 6 months. Families (N = 118) who participated in PACT II and PACT III are included in the current analyses, who were assessed every 6 months for 36 months in PACT II, and every 6 months for 18 months in PACT III (providing 11 time points of data across 8 years). Growth curve modeling was applied to assess the associations of maternal health on adolescent psychosocial outcomes. In terms of their relationship with their mother living with HIV (MLH), adolescent psychosocial functioning was negatively impacted by maternal illness, specifically viral load count and vitality levels, while several indicators of increased maternal illness (including viral load, vitality, illness symptoms, health-related anxiety) predicted less attachment with peers. In addition, MLH increased illness was associated with more adolescent autonomy.
PMCID: PMC3532885  PMID: 23284586
3.  Impact of Maternal HIV Health: A 12-year Study of the PACT Children 
The purpose of this 12-year longitudinal study was to assess the effects of maternal HIV/AIDS on child/adolescent well-being and behavioral outcomes, extending an earlier published account.
Interviews were conducted with 66 pairs of healthy children and their mothers living with HIV/AIDS (MLH), who are participants in the Parents And children Coping Together (PACT) project begun in 1997. All study participants were English or Spanish speaking. About half (48.5%) of the youth were female. Maternal health status (e.g., viral load biomedical marker, illness symptoms, physical functioning and depression) and child/adolescent outcomes (e.g., depression, anxiety/worry, aggression, and self-concept) were assessed over 16 time-points.
Using growth curve modeling, results show a negative effect of maternal health status on child/adolescent outcomes, including child/adolescent depression, anxiety/worry, aggression, and self-concept. Interaction effects within the growth models suggest younger children are more impacted by poor maternal health than are older children/adolescents.
This is the first study to follow a cohort of children of MLH over such an extended age range, through late adolescence/early adulthood, to determine the impact of maternal health status throughout the entire developmental period.
PMCID: PMC3458713  PMID: 22999830
HIV; Longitudinal Studies; Child Behavior; Child Development; Adolescent Behavior; Adolescent Development
4.  Pilot Trial of a Disclosure Intervention for HIV+ Mothers: The TRACK Program 
The Teaching, Raising, And Communicating with Kids (TRACK) program was a longitudinal pilot-trial intervention designed to assist mothers living with HIV (MLH) to disclose their serostatus to their young children (age 6 – 12 years).
MLH and child dyads (N = 80 dyads) were recruited and randomized to intervention or control; the intervention group had three individual sessions and one follow-up phone call. The sessions focused on preparing MLH for disclosure through behavioral exercises utilizing Derlaga’s model of HIV-disclosure. Both MLH and their child were assessed across multiple time-points (baseline, 3-, 6-, and 9-months) regarding disclosure of HIV status, and specific outcome variables (i.e., relationship context, mother’s health, child’s mental health, and family outcomes).
MLH in the intervention group were six times more likely to disclose their HIV status than those in the control group (O.R. 6.33, 95% C.I.: 1.64 – 24.45), with 33% disclosing in the intervention group compared to 7.3% in the control group. MLHs in the intervention group showed increases in disclosure self-efficacy across time, increased communication with their child, and improvement in emotional functioning. Children of MLHs in the intervention group exhibited reductions in depression and anxiety, and increases in happiness.
TRACK was found to be successful in helping MLH disclose their HIV status to their children, with positive outcomes noted for both MLH and their children.
PMCID: PMC3066305  PMID: 21355637
HIV; mothers; intervention; disclosure
5.  Anxiety/Stress among Mothers Living with HIV: Effects on Parenting Skills & Child Outcomes 
AIDS care  2010;22(12):1449-1458.
Parental HIV infection has been associated with negative outcomes for children, and parenting skills appear to be one mechanism operating in that association. The present study focuses on the relations between maternal stress, parenting, and child functioning among families where the mother is living with HIV. Sixty-nine mothers with at least one child between 6 and 12 years old completed questionnaires at the baseline assessment of an intervention designed to facilitate maternal disclosure of HIV status. Respondents were assessed using multiple measures of stress/anxiety, and parenting skills and child outcomes, including the Parenting Stress Index, the RAND Mental Health Inventory, the Family Routines Questionnaire, and the Child Behavior Checklist. Covariance structural modeling was used to assess the variable relationships, with latent constructs created for maternal anxiety/stress, parenting skills, and child problem behaviors (both direct and indirect effects were evaluated, with a model-based bootstrap used to verify model stability). Results demonstrated that maternal stress was negatively associated with a broad range of parenting skills, and that parenting skills were negatively associated with child problem behaviors. Mothers living with HIV who are anxious about their own health and functioning, and who were more stressed in their parental role, were more likely to exhibit poorer parenting skills—specifically to engage children less frequently in family routines (e.g., eating meals together, having a bedtime routine), poorer parent-child communication, and poorer and less consistent parenting discipline. Not uncommonly, mothers living with HIV experience a range of stressors above and beyond those related to their illness (e.g., poverty, residence in high risk and low resource communities, discrimination). Results demonstrate the need for interventions designed to decrease maternal stress and enhance parenting skills for families affected by HIV.
PMCID: PMC3000905  PMID: 20824552
HIV; maternal stress; parenting; child functioning
6.  Predictors of Sexual Behavior Among Early and Middle Adolescents Affected by Maternal HIV 
The impact of maternal HIV and family variables on sexual behaviors of early and middle adolescents was investigated. Data were collected from 118 pairs of HIV-positive mothers and their uninfected early/middle adolescents across four time-points. Descriptive analyses show the prevalence of sexual behaviors in this sample was significantly lower than rates in a comparable sample of adolescents who participated in the Youth Risk Behavior Surveillance System. Multivariate longitudinal analysis using GEE logistic regression showed adolescent sexual behavior was more likely to occur with adolescent alcohol use, lack of parental monitoring, and poorer physical functioning of HIV+ mothers.
PMCID: PMC3190179  PMID: 21998620
HIV; Adolescent; Risk-Taking; Sexual Behavior
7.  Family Routines and Parental Monitoring as Protective Factors Among Early and Middle Adolescents Affected by Maternal HIV/AIDS 
Child development  2009;80(6):1676-1691.
The influence of parenting skills on adolescent outcomes among children affected by maternal HIV/AIDS (N = 118, M age = 13) was investigated. Among families with more frequent family routines, over time adolescents showed lower rates of aggression, anxiety, worry, depression, conduct disorder, binge drinking, and increased self-concept. Among families with higher levels of parental monitoring, adolescents showed significant declines in anxiety and depression, conduct disorder, and binge drinking, along with increased self-concept. Mothers’ level of illness was associated with parenting. Greater variability in parental monitoring resulted in higher levels of problem behaviors.
PMCID: PMC3068620  PMID: 19930345
8.  Maternal HIV/AIDS and adolescent depression: A covariance structure analysis of the “Parents and Adolescents Coping Together” (PACT) model 
The current study assessed the efficacy of selected variables from the Parents and children Coping Together (PACT) model, which was designed to predict maternal HIV effects on child/adolescent outcomes. Data from two longitudinal studies applying PACT measures were utilized, encompassing a seven-year assessment timespan for HIV-infected mothers and their children. Both maternal and child-based measures were evaluated, and a sequential longitudinal design was adopted. Structural equation modeling using FIML was performed to assess the proposed model. Results show the PACT model was viable in predicting child/adolescent outcomes of self-concept and depression. Study implications are discussed, including the influences of maternal factors on child’s self-concept and depression, and a reconsideration of the affect of family cohesion on child/adolescent outcomes.
PMCID: PMC2832295  PMID: 20209025
Maternal HIV; Child self-concept; Child depression; Structural equation modeling
9.  Resiliency in Young Children Whose Mothers are Living with HIV/AIDS 
AIDS care  2008;20(3):284-291.
Resiliency was investigated among well children 6 - 11 years of age (N = 111) whose mothers are living with AIDS or are HIV symptomatic to determine if mother’s HIV status was a risk factor that could effect child resiliency, as well as investigate other factors associated with resiliency. Assessments were conducted with mother and child dyads over 4 time points (baseline, 6-, 12-, and 18-month follow-ups). Maternal illness was a risk factor for resiliency: as maternal viral load increased, resiliency was found to decrease. Longitudinally, resilient children had lower levels of depressive symptoms (by both mother and child report). Resilient children also reported higher levels of satisfaction with coping self-efficacy. A majority of the children were classified as non-resilient; implications for improving resiliency among children of HIV-positive mothers are discussed.
PMCID: PMC2422847  PMID: 18351474
HIV; Resiliency; Child; Maternal Illness

Results 1-9 (9)