Background:  With recent advances in treatment, children and adolescents with perinatally acquired HIV infection are now surviving well into late adolescence and adulthood. Data are needed to inform policy makers regarding the educational and mental health needs of this population.

Methods:  During 2003, data were collected via interview with the caregiver for 136 pediatric HIV-infected school-age children at 3 U.S. HIV Research Network sites. Children <5 years were excluded. Any visit to any psychiatric provider not for drug and alcohol abuse was defined as a mental health visit.

Results:  The median age was 11 years (range 5 to 18) and 54% of the subjects were female; 64% were African American, 21% Hispanic, and 8% Caucasian; 30% met the definition of AIDS; 59% had been disclosed of their HIV status; 24% used mental health services (median number of 3 visits; range 1 to 50) and 41% used special education services; 13% were taking medicines for depression or anxiety or attention deficit disorders. In multivariate regression, boys (adjusted odds ratio, AOR, 2.69; 1.13 to 6.36), those who lived alone (most of whom were homeless) compared to those living with parents (AOR 3.00; 0.83 to 10.90), and those with private insurance used of mental health services more than those on Medicaid (AOR 4.76; 1.18 to 20.66). In multivariate modeling, only mental health visits (AOR 7.46; 2.54 to 21.94) were associated with the usage of depression or ADD/ADHD medications. In bivariate regression, parents who had graduated from high school (OR 2.62; 1.00 to 6.85) or college (OR 4.91; 1.10 to  22.0) were more likely to have a child in special education than those with less than a high school education. Hispanic caregivers (OR 0.12; 0.021 to 0.63) were less likely than Caucasian or black caregivers to have children receiving special education.

Conclusions:  Compared to nationally reported values, where 12% of all school children receive special education services and 6 to 9% receive mental health services, this cohort of HIV-infected children and adolescents had a very high rate of mental health and special education service usage. HIV pediatric providers should screen patients for special educational and mental health needs.