Qualitative study exploring parenting among mothers and female caregivers living with the IPV, mental health and HIV syndemic in South Africa

Background In South Africa, women disproportionately bear the burden of intimate partner violence (IPV), HIV or AIDS, and poor mental health. Objective This study investigated parenting practices among women affected by IPV, HIV and poor mental health syndemics. Study setting The study was conducted in two sites, a peri-urban area and a rural area in Mpumalanga, South Africa. Study design A qualitative research design using a narrative approach with in-depth interviews supported by arts-based methods was used. Data were analysed thematically using MAXQDA (2022). Participants 20 women aged 20-60 who screened positive for HIV, IPV and/or poor mental health in a larger three-generational cohort study were selected. Results Living with the syndemics exacerbated socioeconomic challenges that often translated into an inability to meet basic child needs. Socioeconomic challenges also led to more harsh parenting practices among women living with IPV-Mental Health and HIV-Mental Health syndemics. Due to lack of trust from family members, women living with the HIV-Mental Health-IPV syndemic were often separated from their children. These women exhibited less harsh parenting practices than the women in the other syndemic groups when they did see their children. A history of childhood trauma, leading to overprotective parenting, was common across the groups except for the IPV-Mental Health group. Women in the IPV-Mental Health group often had strained relations with their children's fathers, affecting their engagement and connection with their children. Conclusion The study underlines challenges experienced by women with IPV-Mental Health, HIV-Mental Health and HIV-Mental Health-IPV syndemics. The overlap of these epidemics strains women's relationships and affects women's parenting practices detrimentally resulting in an inadequate provision for children's needs.