HIV Disclosure and Family Processes Among Mothers Living with HIV and Their Children: A Mixed-Methods Longitudinal Investigation

Despite recent reductions in HIV incidence in the U.S., African American and Latina women remain significantly overrepresented in HIV prevalence rates. Many women living with HIV are primary caregivers and are now living long enough to raise their children. Mothers living with HIV (MLH) face unique stressors, including elevated parenting stress, barriers to effective parenting, decisions related to disclosing their HIV status, and risk of child adjustment difficulties. Though studies have demonstrated cross-sectional relations among these family processes for MLH and their children, none have explored these processes transactionally across time. The current study was a longitudinal, mixed-methods examination of mothers’ HIV disclosure to children and its interplay with parenting quality, parenting stress, and child psychosocial adjustment. In the context of a randomized controlled trial evaluating an HIV disclosure intervention, a sample of 174 MLH and their children were recruited from two sites. Quantitative data were collected over four waves spanning 15 months. Qualitative data were collected with a subsample of 14 families in which disclosure had occurred. Two longitudinal structural equation modeling approaches—latent change score (LCS) modeling and cross-lagged panel analysis (CLPA)—were employed to examine relations among HIV disclosure, child adjustment, parenting, and parenting stress. Qualitative interviews were conducted to enrich the quantitative findings by further exploring families’ perspectives of these processes. Results of LCS models demonstrated that HIV disclosure led to subsequent improvements in parenting stress and children’s perceptions of parent-child communication and relationship quality. Changes in parenting stress inversely predicted changes in parental involvement. In the CLPA framework, several unidirectional and bidirectional relations were observed between mean levels of parenting stress and child adjustment, between child-reported parenting quality and child adjustment, and between child- and mother-reported parenting quality and parenting stress. Qualitative themes mirrored quantitative findings and provided explanation and contextualization for these findings. Results highlight the complex and multifaceted nature of the interplay among HIV disclosure, parenting practices, parenting stress, and child functioning. Findings suggest that MLH should be supported in disclosing their serostatus to their children to minimize parenting stress, bolster parenting skills, and promote positive outcomes for youth