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To determine factors related to the timing and probability of nondisclosure of HIV status to perinatally HIV-infected children, and to explore factors associated with emotional distress in HIV-infected children. Methods: This is a cross-sectional study of 51 HIV-infected children based on medical records, parent interviews, and child assessments.1) Probability of earlier age of disclosure is associated with higher child IQ (p = .04) and more family expressiveness (p = .01); 2) controlling for child age, disclosure status at time of study is associated with major life events, but not with medical status; and 3) factors associated with increased parent-rated anxiety in HIVinfected children in univariate analyses are: HIV disclosure (p = .04), other major life events (p = .001), higher medication dose frequency (p = .01), and child age (p = .01). Increased depression is associated only with more medication doses (p = .02).These data indicate that higher child IQ and greater family expressiveness increase the probability of earlier diagnostic disclosure to HIV-infected children. Factors associated with emotional distress highlight important areas of clinical attention. These data suggest that diagnostic disclosure may not necessarily minimize emotional distress, indicating the need for further evaluation of the appropriate timing and type of disclosure for pediatric HIV.