Children of HIV-infected parents: Custody status in a nationally representative sample

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.