Published online February 1, 2007
PEDIATRICS Vol. 119 No. 2 February 2007, pp. e391-e398 (doi:10.1542/peds.2006-1459)
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ARTICLE

Guardianship Planning Among HIV-Infected Parents in the United States: Results From a Nationally Representative Sample

Burton O. Cowgill, MPHa,b, Megan K. Beckett, PhDc, Rosalie Corona, PhDa,d, Marc N. Elliott, PhDc, Michelle T. Parra, PhDe, Annie J. Zhou, MSc and Mark A. Schuster, MD, PhDa,b,c

a Department of Pediatrics, Mattel Children’s Hospital, David Geffen School of Medicine
b Department of Health Services, School of Public Health, University of California, Los Angeles, California
c RAND, Santa Monica, California
d Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
e Los Angeles County Department of Public Health, Los Angeles, California

OBJECTIVE. The purpose of this work was to determine the rates and predictors of guardianship planning and preferred guardians among HIV-infected parents.

PARTICIPANTS AND METHODS. Data were analyzed from interviews with 222 unmarried parents (who had 391 children) from a nationally representative sample of HIV-infected adults receiving health care. Outcome measures included parental report on the level of guardianship planning and on who their preferred guardian for each child was. Level of guardianship planning was categorized as follows: (1) parent had not identified a guardian; (2) parent had identified a guardian, but the guardian had not agreed; (3) identified guardian had agreed; and (4) legal documentation of guardianship plan was complete. We conducted bivariate and ordered logistic regression analyses on the level of guardianship planning and multinomial logistic regression on identification of preferred guardians.

RESULTS. Twelve percent of unmarried HIV-infected parents had not identified a guardian; 6% had identified a guardian but gone no further; 53% said the identified guardian had agreed; and 28% had prepared legal documentation. The preferred guardians included other biological parents (17%), spouse/partners who were not biological parents (2%), grandparents (36%), other relatives (34%), friends (7%), unrelated adoptions (1%), and others (3%). Parents with the lowest CD4 counts and parents living without other adults were more likely to have completed the guardianship planning process. Nonrelatives were most often preferred by mothers and parents with higher CD4 counts; grandparents were most often preferred by younger parents and parents who prefer speaking Spanish.

CONCLUSIONS. Pediatricians and others who take care of children with HIV-infected parents may be able to provide counseling and referrals for guardianship planning.

Key Words: HIV • children and adolescents

Abbreviations: HCSUS—HIV Cost and Services Utilization Study • MSA—metropolitan statistical area • HAART—highly active antiretroviral therapy

Accepted Aug 14, 2006.