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An increasing proportion of newly diagnosed AIDS cases is being reported among African American urban women. Recent research regarding the psychosocial and behavioral impact of a mother''s HIV status on her uninfected children as well as a growing body of clinical evidence suggest that these children are extremely vulnerable and at risk for problems in psychosocial adjustment. The present paper reports the results of research designed to examine the pathways by which a mother''s HIV-positive status affects the psychosocial adjustment of her uninfected school-age child. The principal predictor variables of the model are family sociodemographic characteristics, social support available to mother and child, HIV-related symptom distress in the mother, coping strategies of both mother and child, emotional distress of the mother, and quality of the parent–child relationship. The dependent variable is the psychosocial adjustment of the child. Data were collected on 147 mother–child dyads using standardized questionnaires and personal interviews. Eighty-six percent of the mothers were African American and over 96% were on public assistance. Structural equation modeling was used to test the proposed model of mother–child coping and adjustment. After adding three paths, the model had a good fit to the data (comparative fit index=0.94; root mean square estimate of error=0.06). Five model constructs accounted for 36% of the variance in child adjustment. The constructs in order of importance were maternal HIV-associated stressors, maternal emotional distress, child social support, child coping, and quality of parent–child relationship. [Copyright &y& Elsevier]