Caregiving experiences, challenges and needs of mothers for their young children who are HIV exposed and uninfected from Worcester, South Africa – A qualitative exploration through the nurturing care framework

In high HIV prevalence settings, pregnancy and early childhood can be stressful periods for mothers with HIV, due to fear of HIV transmission, breastfeeding concerns, poor health and socio-economic challenges. Not much is known about how mothers of young children who are HIV exposed and uninfected (HEU) experience caregiving before and beyond the confirmation of their HIV-negative status. Using the Nurturing Care Framework for early childhood development, this qualitative study explores the caregiving experiences, challenges, and support needs of mothers raising young children who are HEU. Conducted in the Western Cape, South Africa, the study involved in-depth interviews with 20 mothers whose children were exposed to HIV, >1 year old, and tested HIV negative at 12 months. Reflexive thematic analysis guided the data analysis. Mothers' concerns persisted beyond ruling out HIV to encompass the overall health and development of their child during early years of life. Nurturing care practices were hindered by structural challenges - financial constraints, heavy caregiving demands, their own poor health, and limited partner/family support, which were further intensified by mothers' HIV and their child's HIV exposure. Existing efforts to operationalise the Nurturing Care Framework in high-HIV settings need to be strengthened to consider the specific needs and vulnerabilities of mothers of children who are HEU.