Parenting difficulties of mothers with HIV/AIDS and HIV/AIDS-psychosis: a systematic literature review

Aim: South Africa has the world’s highest prevalence of HIV/AIDS: in 2009 approximately 5.6 million people lived with HIV/AIDS, that is approximately 11% of the national population. HIV/AIDS is reported for 32.7% of the women aged between 25 and 29 years and 29.1% between 30 and 34 years. Psychotic disorder associated with HIV tends to surface when the illness has progressed to its later stages of development and affects an estimated 0.2 to 15% of HIV+ patients. Due to her chronic physical symptoms, but also due to her psychiatric symptoms the infected mother may be less physically or emotionally available for her developing child or display confusing or frightening behavior, resulting in insecure or disorganized attachment relationships. This systematic literature review describes and synthesises studies addressing the parenting difficulties of mothers with HIV/AIDS and HIV/AIDS-psychosis in order to better understand its effects on parenting. Method: Academic Search Premier, Africa-Wide Information, CINAHL, ERIC, Health Source, Medline/Pubmed, PsycARTICLES and PsycINFO databases were searched via EBSCOhost for relevant articles from 1997 to 2011 resulting in 4370 articles. Findings from fifty-one peer reviewed articles were deemed relevant using defined inclusion criteria. Results: None of the studies simultaneously focused on the topics HIV/AIDS, psychotic disorders and parenting. Studies identified a number of resilience factors that partly offset the risk of HIV/AIDS, namely an improved maternal bond and motherhood being a source of hope, esteem, motivation. Identified risks include parental concerns and stressors as well as physical illness and hospitalization; with social relations and support being a risk factor as well as a resiliency factor. Studies on parents with psychosis report decreased theory of mind and -mentalization, poor social relationships and –support networks, abnormal parental behavior, insensitive caregiving and problematic attachment representations which result in poor parenting outcomes. Conclusion: A moderation model integrates the results. Psychosis is likely to exacerbate the effects of HIV/AIDS on parenting. Increased awareness of the likelihood and importance of these symptoms may be used to improve care for families with a mother affected by HIV/AIDS-psychosis.