摘要：This qualitative study explored whether motherhood plays a role in influencing decisions to conceal or reveal knowledge of seropositive status among women living with HIV/AIDS in 2 South African communities: Gugulethu and Mitchell's Plain. Using the PEN-3 cultural model, we explored how HIV-positive women disclose their status to their mothers and how HIV-positive mothers make decisions about disclosure of their seropositive status. Our findings revealed 3 themes: the positive consequences of disclosing to mothers, how being a mother influences disclosure (existential role of motherhood), and the cost of disclosing to mothers (negative consequences). The findings highlight the importance of motherhood in shaping decisions to reveal or conceal knowledge of seropositive status. Implications for interventions on HIV/AIDS prevention, care, and support are discussed. The literature on the experiences and factors that influence disclosure of HIV seropositive status among women in many developed countries is quite extensive. 1 – 9 However, in sub-Saharan African countries like South Africa where the prevalence of HIV remains high, 10 there is scant evidence on the disclosure experiences of women. Inevitably, the available evidence fails to explore the broader contextual factors that influence women's decisions to conceal or reveal their seropositive status. For example, Makin et al. 11 explored individual factors that influence disclosure among pregnant women in South Africa, but it remains unclear whether collective contexts such as mother–daughter relationships or aspects of motherhood (i.e., the desire to nurture and protect children, and so on) play a critical role in influencing women's decisions to disclose. A better understanding of factors such as the concept of motherhood is essential to understanding how women disclose and cope with living with their seropositive status. Moreover, such insights could help advance and focus public health intervention efforts to reduce HIV- and AIDS-related stigma and discrimination, prevent new HIV infections, promote effective care, and support strategies for mothers and women living with HIV and AIDS. The discourse on notions of motherhood in sub-Saharan Africa in general and in South Africa in particular has long been a subject of interest to many researchers over the decades. Previous studies have described motherhood as a form of collective identity, the analysis of which is useful in understanding not only the critical role the mother plays in a child's welfare but also the roles and expectations of being mothers. 12 – 15 Two aspects of motherhood are examined in this study. First, what is most unstated about motherhood is that it is a lifelong commitment—one remains a child to one's mother regardless of one's age. 13 , 16 Mothers play a crucial role not only as birth givers but also as life givers, as one needs one's mother at every turn in life. 13 Second, as Magwaza noted, “mothering is not only about children but also the mothers who are involved in the actual practice.” 17 (p14) Because child care is often the sole responsibility of mothers, there is a generally held view that all mothers are expected to provide emotional care and support for their children. However, in some cases it is not uncommon to have “contradictions between what societies expect of mothers and what mothers themselves do” 17 (p14) (as in the case of mothers abusing their children). Kruger noted that the discourse on motherhood is much more complex than simply describing “mothering practices as either fulfilling/successful or difficult/problematic.” 18 (p196) Instead, it is important to note that the act of mothering may entail different meanings to different women and that these meanings are often influenced by the historical, sociocultural, and economic contexts of the women who are doing the mothering. 18 In the context of HIV and AIDS disclosure, it is imperative to understand these different meanings of motherhood (particularly as women living with HIV and AIDS try to decide whether to reveal or conceal their seropositive status) as well as issues related to emotional care, support, stigma, and discrimination. In South Africa, the discourse on motherhood cannot be separated from the history of institutional discrimination that occurred within South Africa, particularly during apartheid. The apartheid era was a critical period in South Africa that led to forced removals and dislocations of families and communities and also weakened families’ capacities to care for their family members. 17 , 19 Apartheid, alongside various interrelated racial, ethnic, historical, political, and socioeconomic circumstances, also influenced the nature and characteristics of mothering practices in South Africa. 17 , 19 – 21 Although it is important to take ethnic differences (such as being African, Indian, or Colored) into account when contextualizing motherhood in South Africa, there is minimal evidence on how mothering practices differ across ethnicities. The existing literature highlights similarities in mothering practices between ethnicities as related to nurturing and providing care for family members. For example, Magwaza 17 noted that among African mothers, informal adoptions were on the rise. Much of the task of providing basic needs such as education, food, and clothing to relatives were carried out by these mothers, “who did not consider themselves as mothers to their biological children only.” 17 (p7) Field has argued that Colored mothers are viewed “not only as the maternal head of the family, but also the moral authority of the family,” 21 (p64) noting that even in male-headed households, these mothers often assume the central role of disciplining, teaching, and nurturing the children. Colored mothers are expected to teach their children ideals related to preserving the dignity of their households. The significance of mothers as nurturers as well as symbols of moral authority and dignity 21 within families has particular relevance in the context of the HIV and AIDS epidemic in South Africa, as young women now account for about 90% of new HIV infections. 22 , 23 Given the burden of HIV and AIDS alongside the legacy of apartheid, it is possible that the combination of these factors may affect traditional and societal expectations of mothering practices in South Africa, particularly in the context of disclosing seropositive status. We expand the current literature on disclosure of HIV/AIDS status among women in South Africa by exploring whether motherhood plays a role in influencing decisions to conceal or reveal knowledge of seropositive status. In particular, we explored how HIV-positive women disclose their status to their mothers and how HIV-positive mothers make decisions about disclosure of their seropositive status. Because motherhood in general occupies an important focus around which individual and collective identities are structured, 13 we suggest that it can provide an anchor on which people living with HIV and AIDS can gain emotional care, support, and acceptance as well as buffer the negative factors associated with HIV and AIDS infection, such as stigma and discrimination. We also argue that the critical but often obscure position of mothers can serve as a useful guide for exploring the factors that influence decisions on disclosure of seropositive status. Given that issues surrounding HIV and AIDS disclosure are central to notions of identity, expectations, and belongingness, we explored the context of motherhood within disclosure of HIV and AIDS status using the PEN-3 cultural model developed by Airhihenbuwa. 12 , 24 , 25
