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Many Children of HIV-Positive Parents Are Not in Their Custody

A new joint study by UCLA and the Rand Corp. shows that more than half of children with an HIV-infected parent are not consistently in that parent’s custody.

Researchers found that during the two-year study period, 42 percent of children were not in the HIV-infected parent’s custody at any time.

The research is the first to use data from a nationally representative sample of people in care for HIV infection to investigate the custody status of children. The findings will be presented at the annual meeting of the Pediatric Academic Societies in Toronto on May 7.

“Children of HIV-infected parents are at risk for behavioral and emotional problems. A stable home may help these children and their parents cope with the effects of HIV on the family,” said lead author Burt Cowgill, M.P.H., a doctoral candidate in the department of health services at the UCLA School of Public Health and a researcher at the UCLA/Rand Center for Adolescent Health Promotion. “By understanding whether children of HIV-infected parents remain in their parent’s custody, pediatricians and other physicians may be able to help families address custody issues and offer referrals to social services.”

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Cowgill added that pediatricians may also want to suggest that HIV-infected parents include future custodians in their children’s doctor visits so that these individuals are familiar with the physical and mental health needs of the children.

Using data from the Rand Corp.’s HIV Cost and Services Utilization Study, the team investigated whether HIV-infected parents had maintained custody of their children during the two-year period from 1996 to 1998. They found that 47 percent of children remained in the custody of an HIV-infected parent, while 42 percent were not in the parent’s custody at any time. The remaining 11 percent were out of their parent’s custody at some time during the study period.

HIV-infected fathers, parents with more advanced HIV disease, drug-using parents and parents with at least one hospital stay were less likely to have custody of their children.

A child’s other biological parent or other family members (grandparents, aunts/uncles) were most likely to be the alternate custodian. Parents cited drug use (62 percent) and financial hardship27 percent) most often as reasons for losing custody of their children. Only 10 percent of HIV-infected parents mentioned the effects of HIV/AIDS as a reason for not maintaining custody of their children.

“Improved treatments for HIV have enabled many HIV-infected parents to live longer. Parents continue to face obstacles that can affect their ability to maintain custody of their children, including financial hardship, ongoing drug use, and the effects of HIV/AIDS and medications used during treatment,” said the study’s primary investigator, Dr. Mark Schuster, professor of pediatrics and public health at the David Geffen School of Medicine at UCLA and director of health promotion and disease prevention at RAND.

This research was supported by the National Institute of Child Health and Human Development and the Centers for Disease Control and Prevention. The original data collection was supported in part by the Agency for Health Care Policy and Research.

In addition to Cowgill and Schuster, study authors included Megan K. Beckett, Ph.D.; Rosalie Corona, Ph.D.; Marc N. Elliott, Ph.D.; and Annie J. Zhou, M.S.

HBV/HIV Co-infection

What is HBV/HIV Co-infection?

A person who is infected with both the hepatitis B and the HIV viruses is said to have a HBV/HIV Co-infection. Approximately 10% of the HIV-infected population worldwide is infected with hepatitis B. This figure may approach 20% in Southeast Asia, and 5% in North America and Western Europe.

Since both the hepatitis B virus and the HIV virus share similar transmission routes, it is not surprising that there is a high frequency of co-infection. Sexual activity and/or injection drug use are the most common routes of transmission of the hepatitis B virus among those also infected with HIV.

While highly active antiretroviral therapy (HAART) has dramatically improved the lives of those with HIV, the consequences of associated illnesses such as hepatitis B co-infections have become more relevant.

Conditions associated with hepatitis B and C are currently among the leading causes of hospital admission and death in the HIV-infected population. Therefore, the adequate management of hepatitis B and C is now being considered a priority in HIV-coinfected patients.

Since there is not a ‘cure’ at this time for hepatitis B, the main goal of treating HBV/HIV-co-infection is to stop or slow down HBV viral activity as much as possible and for as long as possible.