'"I'm Alright, I Can Raise My Children": The Evolving Struggle of Motherhood in the Context of HIV
Women represent more than 60% of HIV-positive people in sub-Saharan Africa and nearly 75% of all HIV infections among ages 15-24 (UNAIDS, 2011). This disproportionate impact of HIV/AIDS on women calls attention to links between gender roles, socioeconomic status, and HIV incidence. These disparities are even more pronounced for women whose roles encompass parenting and child rearing in addition to the burden of HIV. Their unique struggles—including disclosure, stress, stigma, and limited participation in their children’s lives (Murphy et al., 2011; Sandelowski & Barroso, 2003)—are only beginning to be understood in the context of structural constraints such as poverty and rigid gender norms.
Research to explore the economic and gender-related factors driving these disparities is critically needed (MacPherson, et al., 2012; Seeley, et al., 2012). A social work approach to understanding social development and health disparities emphasizes participation of local people to improve collective well-being (Midgley, 2014) and places central focus on structural issues such as poverty. Following that approach, this study used participatory evaluation methods to examine the lived experiences of HIV-positive single mothers participating in a community-based micro-enterprise initiative in Kenya.
Methods
Semi-structured interviews conducted between May-July 2013 focused on pathways to HIV infection, experiences as HIV-positive women and mothers following diagnosis, and perceived impact of participation in the social development initiative. Interviews were conducted in English and several local languages then translated and transcribed verbatim in English. Prolonged engagement, reflexivity, member checking, and peer debriefing were used to address trustworthiness of findings (Lincoln & Guba, 1985). Data were independently analyzed by the two authors who then compared codes and identified emerging themes collaboratively. Analysis yielded 17 open codes that were then collapsed into five trees representing major themes with ‘mothering’ emerging as a major theme.
Results
Participants (n=27; ages 20-48) were single mothers with between 1-6 children from five rural villages and two urban slums in Kenya. Data analysis revealed an evolving struggle of motherhood in the context of HIV. Specifically, four themes emerged: (1) Provision (concrete needs such as food and school fees for children), (2) Disclosure of HIV status (timing, approach, and consequences for the family), (3) Children’s well-being (before the micro-enterprise intervention and after), and (4) Selflessness of motherhood (putting children first even at the cost of mother’s own health). More broadly, the notion of ‘struggle’—and its evolution—emerged as a pervasive, overarching theme throughout the interviews. Although it was still evident at the conclusion of the women’s narratives, this struggle had in many instances transcended from its initial urgency into a re-imagining of a viable future for participants and their children.
Conclusions and Implications
Findings suggest that motherhood profoundly shapes women’s experiences of HIV, presenting both unique challenges and important context for increased personal agency and longevity. The extraordinary efforts women made to engage in caregiving despite their physically compromised states suggests that mothering roles must be a central component of successful HIV prevention and treatment efforts. Implications for international social work practice and research will be discussed.