Commentary: coping over the long haul: understanding and supporting children and families affected by HIV disease.

opmental delays, disruption of daily activities such as school attendance, and premature death (Yoos, 1987). Other distinguishing issues associated with HIV/AIDS are secrecy, stigma, isolation, and multiple losses. Among children and families, we add to this list multigenerational disease, multigenerational loss, and interaction with previous family problems such as substance abuse. Further, many families affected by HIV/AIDS are also dealing with social issues such as poverty, homelessness, and inadequate access to medical, social, and educational resources (Lewis, Haiken, & Hoyt, 1994; Steiner, Boyd-Franklin, & Boland, 1995). Any one of these issues has the potential to cause psychological distress and poor adjustment. In combination, they pose increased risk for children and families affected by HIV disease. The confluence of medical, psychological, and social factors in HIV gives rise to a breadth of issues. Among the most critical are developmental needs of children with HIV infection, special concerns of uninfected children in the family, adjustment of children and families, impact of HIV infection on parenting, psychosocial problems parents face, stress and coping among children and families, family functioning, changes in family structure and functioning related to disease progression, permanency planning, disclosure of HIV diagnosis, treatment adherence, management of loss and grief, and HIV prevention, as well as interactions among these issues. This seemingly unending list accentuates the Journal of Pediatric Psychology, Vol. 26, No. 6, 2001, pp. 359–361