Published online August 31, 2007
PEDIATRICS Vol. 120 No. 3 September 2007, pp. e494-e503 (doi:10.1542/peds.2006-3319)
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ARTICLE

Children of HIV-Infected Parents: Custody Status in a Nationally Representative Sample

Burton O. Cowgill, MPHa,b, Megan K. Beckett, PhDc, Rosalie Corona, PhDa,d, Marc N. Elliott, PhDc, 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
d Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
c Rand, Santa Monica, California

OBJECTIVE. The purpose of this work was to determine the rates and predictors of custody status for children of HIV-infected parents.

PARTICIPANTS AND METHODS. Data came from interviews of 538 parents with 1017 children (0–17 years old) from a nationally representative sample of HIV-infected adults receiving health care in the United States. Outcomes were collected at 2 survey waves and included child custody status and who, other than the HIV-infected parent, had custody of the child. Child custody status was categorized as (1) in custody of HIV-infected parent at both survey waves, (2) infected parent had custody at first survey wave but not second survey wave, (3) not in custody of infected parent at either survey wave, and (4) infected parent gained custody between survey waves. Potential custodians included (1) other biological parent, (2) state, foster, or adoptive parent, (3) grandparent, and (4) relative, friend, nonbiological parent, or other. Multinomial logistic regression modeled both outcomes.

RESULTS. Forty-seven percent of the children were in the custody of their HIV-infected parent at both survey waves, 4% were in the parent's custody at the first but not second survey wave, 42% were not in custody at either survey wave, and the parent of 7% gained custody between survey waves. Parents cited drug use (62%) and financial hardship (27%) as reasons for losing custody. Children of HIV-infected fathers, older parents, parents living without other adults, parents with low CD4 counts, drug-using parents, and parents with ≥1 hospital stay were less likely to be in their parent's custody at either survey wave.

CONCLUSIONS. More than half of the children were not in custody of their HIV-infected parent at some time during the study period. Pediatricians and others taking care of children with HIV-infected parents may be able to offer counseling or referrals to assist parents with child custody issues.

Key Words: HIV • children and adolescents

Abbreviations: HCSUS—HIV Cost and Services Utilization Study • IDU—injection-drug user • MSM—men who had sex with men • HAART—highly active antiretroviral therapy • OR—odds ratio • CI—confidence interval

Accepted Mar 19, 2007.