This study explores discrepancies in perceiving family conflict between HIV-infected parents and their adolescent children aged 12 to 22. A representative sample of 382 adolescent children and their HIV+ parents were recruited and assessed over 4 years. Relationships between discrepancies in perception and family demographics and the impact of discrepancies on adolescent adjustment are examined. A significant gap in perceiving family conflict was reported between parents and young adolescents aged 12. A higher level of discrepancy was associated with poor economic status, lower parental education, parental hard drug use, and negative parental coping style. Behavioral intervention programs for adolescents must consider both parents' and adolescents' psychosocial status and behavioral indicators as well as their impact on perceptions of family conflict. (Contains 2 tables and 1 figure.)