Adolescent Adjustment over Six Years in HIV-Affected Families

Abstract

Purpose To assess predictors of adjustment of adolescents of parents with HIV (PWH) at three and six years after the delivery of either a coping skills intervention or a standard care condition. Methods A randomized controlled intervention trial was conducted with 288 parents with human immunodeficiency virus (HIV) and their adolescent children. Indicators of adolescent adjustment at both three and six years were examined as a function of intervention condition, demographics, prior behaviors, and parental bonds using structural equation modeling (SEM). Adolescent adjustment at six years was also examined as a function of death of the PWH. Results Protective factors: Youth in the intervention condition reported significantly less substance use three and six years later. In addition, positive parental bonds reported at baseline reduced emotional distress at three years and increased positive future expectations at six years. Risk factors: Substance use at three years predicted heightened sexual risk behaviors, continued substance use, and lower future expectations at six years. Early emotional distress and being Latino predicted increased emotional distress at three years. Parental death by three years predicted more sexual risk behavior and lowered future expectations at six years. Conclusions A time-limited, family based intervention with adolescents of PWH demonstrated both direct and indirect benefits lasting into early adulthood, especially in decreasing substance use, and identifies key risk factors for problematic adjustment, including the death of a PWH.