There has been a steady increase in the number of women and children affected by HIV/AIDS in New York City. Currently there are more than 1,500 cases of pediatric AIDS and it has been estimated that 35,000 children in New York City will lose their mothers to AIDS by 1995. A large percentage of these children affected by human immunodeficiency virus have been prenatally or postnatally exposed to parent drug use. Objectives: This presentation will examine stress, coping, and psychological functioning of HIV-infected children and their uninfected siblings. Study design: Data come from a qualitative study on the effect of pediatric AIDS on 25 families. Caregivers and children were administered a qualitative interview on family structure, stress, coping, and psychosocial needs. This presentation will focus on the children's responses. Participants included 14 HIV-positive children and six uninfected siblings. Their ages ranged from 6 to 16 years of age. Results: The children in these families affected by HIV/AIDS in New York City were primarily cared for by ethnic minority, single mothers who were socioeconomically disadvantaged. Only one-third of the children lived with a birth parent, and none of the children lived in a traditional nuclear family structure. Both HIV-infected children and their uninfected siblings reported experiencing numerous stressful life events including death of a parent, inner-city living conditions, school problems, and family disruption. Fear, sadness, and anger were the most frequently reported emotional responses to stress. While HIV-infected children often coped with this stress by turning to others for social support and help with problem solving, their uninfected siblings primarily relied on themselves, frequently reporting that they had no one to talk to about HIV. Furthermore, uninfected siblings in this sample were often the only children in the house who knew about HIV in the family, and they were frequently asked to engage in caregiving tasks. As a result, they discussed feeling guilt and burden. In spite of these difficulties, few children presented with clinical depression on the Child Depression Inventory, and both HIV-infected and HIV-affected children reported wishes typical of nonaffected children: money, career, toys, and marriage. Conclusions: These data directly illustrate the mental health service needs of children in families affected by HIV disease. A model of care that addresses the biopsychosocial needs of this population will be presented. This model has been implemented with more than 200 children and families.