The parenting intervention included some general topics related to parenting and also included some components to address the specific needs of MLWHs and their children. Social Cognitive Theory guided the development of individual program components. The intervention focused on building four key skills: (1) communicating clearly and effectively with their children, (2) using positive and negative consequences with their children to effectively change child’s behavior, (3) enjoying their children more by finding ways to build quality time together into their normal routine, and (4) taking care of themselves so they can best care for their children.

The parenting intervention aimed to improve communication and monitoring skills of MLWHs. Effective communication involves listening to children and giving them clear instructions of what is expected from them. Further, moms were taught effective discipline strategies to teach their children desirable behavior, while changing the unwanted behavior. Parents are responsible for setting family rules and implementing consistent disciplinary strategies to make sure that those rules are followed. The participating moms were taught how they can establish some ground rules in their home and can use positive and negative consequences to reinforce the desired behavior in their children. The self-control activity was used to teach moms how they can handle frustrating or challenging situations. Further, moms were encouraged to teach their children self-control. By learning and exercising self-control, children can make appropriate decisions and choose behaviors that are more likely to have ­positive outcomes. These parenting skills can help MLWHs manage children’s misbehavior in high-risk situations such as school and community settings.

MLWHs face many physical, psychological, financial, and social issues that are difficult to manage on their own. The parenting intervention encouraged moms to identify and build their social support networks. The program emphasized that moms can improve their quality of life by accessing social support and most importantly, being comfortable asking for help for themselves and their children.

The parenting intervention also focused on strategies to reduce stress faced by MLWHs. The first step to alleviate stress is to recognize stressors and the symptoms of stress. In addition to the health condition, things like past regrets, painful memories, and feeling of guilt can lead to stress. Therefore, the intervention emphasized the need to resolve grudges and conflicts. Other stress-reducing activities included relaxation and deep breathing exercises. Moms were also encouraged to take care of themselves so that they can take care of their children. While coping with HIV and raising children, it is important that MLWHs are able to manage their own emotions.

Recognizing the difficulty many MLWHs have in deciding whether or not to disclose their status to their children (Tompkins 2007: see also Chap.​ 8 in this volume), this was a priority focus of the parenting intervention. There are pros and cons of HIV self-disclosure, in that it both causes and alleviates tension (Smith et al. 2008) and that it can lead to increased receipt of social support from some individuals and stigma, shame, and/or rejection by others. Because there is no clear answer on whether it is beneficial to disclose or not, our intervention discussed the factors that contribute to better decision-making regarding disclosure. Other topics specific to the need of MLWHs included talking with children about death and planning for the future, planning for what will happen and who will take care of their children if something happens to them.

With SCT as its foundation, the MOMS Parenting Intervention incorporated goal setting, role modeling, skills practise with guided feedback, self-monitoring via homework assignments, and reinforcement. Educational activities, problem solving, group discussion, and social support were employed to increase participants’ ability to cope with various issues related to living with HIV.

The attention-control condition provided up-to-date information and education related to living optimally with HIV. Gleaned from formative focus groups conducted to obtain input on the needs of our intended audience, the Healthy MOMS intervention included the topics of medication adherence, nutrition, physical activity, and STDs and HIV and was directly responsive to expressed desires for enhanced knowledge in each of these areas. Additionally, information about effective communication techniques, risk reduction strategies, and strategies for coping with stress are components of the intervention that were indicated as important by women in the focus groups. Finally, there are a number of aspects of the intervention group structure and process that were designed to meet the needs expressed by women and service providers. Sessions were formatted to address each participant as a whole person rather than solely focusing on the topic of HIV; for example, each session involves a “cut and paste” activity, which entails self-reflection about various aspects of the participants’ lives.