Psychological distress, substance use, and adjustment among parents living with HIV.

BACKGROUND Being a parent, especially a custodial parent, living with HIV was anticipated to increase psychological distress and challenges to self-care. METHODS Mental health symptoms, substance use, and health care utilization were assessed among 3818 HIV-infected adults, including custodial parents, noncustodial parents, and nonparents, in 4 AIDS epicenters. RESULTS Custodial parents demonstrated significantly poorer medication adherence and attendance at medical appointments but were similar to nonparents and noncustodial parents in mental health symptoms and treatment utilization for mental health and substance use problems. Noncustodial parents demonstrated the highest levels of recent substance use and substance abuse treatment. Other markers of risk, such as African American ethnicity, lack of current employment income, and injection drug use moderated many of the apparent psychosocial disadvantages exhibited by parents. CONCLUSIONS Interventions specific to the psychosocial stressors facing families living with HIV are needed.