HIV prevalence among South African women attending antenatal clinics is estimated at 30.2 per cent: i.e. nearly one in three pregnant mothers is HIV-positive (Department of Health, 2006). Because this is also the time when women are particularly motivated to test, many discover that they are HIV-positive only when they realise that they are pregnant. Hearing that one is pregnant may produce a variety of emotions and responses. Whether excited or scared or devastated, it is news that changes one's life. In a context in which motherhood is highly valued, there is always recourse to the expectation that one will be admired by others and will experience joy and fulfilment. Hearing that one is HIV-positive produces very different kinds of emotions and expectations, particularly in an environment that is saturated by misunderstanding and horror at the social category of ‘HIV-positive’. The process of becoming both a mother and HIV-positive begins in the moment when the news is received, but proceeds through a series of confusions, prejudices and adjustments in which the process of becoming exists in an uneasy space between internal reality and external discourses. In this sense, it is transitional and paradoxical, with opportunity for painful splits.

This means that HIV-positive mothers enter into two contradictory identities simultaneously: the denigrated, abject and feared identity of being HIV-positive and the idealised identity of motherhood, with all its associations of purity and goodness. Both identities hold complex and competing personal and social meanings, with motherhood and HIV invoking powerful discursive positions. Both motherhood and HIV are created in a moment of intimate sexual contact, but both exist uneasily with sexuality. Motherhood, paradoxically, is associated with chastity rather than sexuality, exemplified in the archetypal Virgin Mary (Kristeva, 1986; Warner, 1976). HIV becomes a metaphor for aberrant sexuality, whether justified or not (Sontag, 1988).

Being diagnosed HIV-positive when one is pregnant means entering into these two contradictory identities, which independently hold complex meanings of loss and gain, creativity and destructiveness, and which collide in the same moment in time. Motherhood is the ultimate act of creativity, in which life is given form.