When Margaret Fleming, founder and executive director of Adoption-Link, an organization specializing in domestic and international adoption, discussed her plans several years ago to open an adoption agency for families in the United States looking to adopt HIV-positive children, people thought she was crazy.

At the time,“No one else was doing this and people didn’t think it was possible with insurance, immigration and other factors,” Fleming said.

However, in 2003 Chances by Choice was formed and has since placed about 60 HIV-positive children with families. The ages of these children range from infants and toddlers to older children about 10 years old.

Chances by Choice, a program of Adoption-Link since 2006, provides services for families looking to adopt children in third world countries, such as Haiti and Ethiopia. They are hoping to develop programs soon in Russia and Kazakhstan.

Fleming said that many people who want to adopt children with HIV are not first time adopters, since adoption in general is a big step. However, she has worked with individuals who planned on adopting a healthy baby, but ultimately adopted one with HIV.

“We often see larger families with a number of adoptive kids wanting to adopt those with HIV,” she said. Unlike many parental requirements at traditional adoption agencies, Chances by Choice’s only minimum requirement is that potential adopters are at least 21 years old. If adopters are married, it must be for at least one year. Chances by Choice does not discriminate and also welcomes unmarried and same sex couples. These same requirements apply for individuals looking to adopt a healthy child through their main program, Adoption-Link.

Adoption requirements are usually more lenient for special needs children, such as those with HIV. However, different countries do have their own rules for adoption regarding marriage length and parent age.

Adoption Advocates International, an adoption agency focusing on children from Ethiopia, China, Thailand, Ghana, and Washington State, said requirements differ in each of these countries.

In Ethiopia, with traditional adoptions of healthy children, couples must be married for a minimum of two years and there can be no more than a forty-three years age difference between the youngest adopting parent and the child. However, if parents are looking for special needs children or older children, these requirements can be altered. Single women are also allowed to adopt HIV-positive children.

In China, some agency requirements state that couples must be 30 to 55 years old to be eligible to adopt. If a parent is over 50 years old, they must be willing to consider a special needs child. Also, if one parent was previously divorced and remarried at the time of adoption, the current marriage must have existed at least five years.

Drawbacks in the Adoption Process

Since relatively few children with HIV are born in the U.S. today, most parents seeking HIV-positive children must look internationally. The process usually takes about a year and requires traveling to that country for a period of time, ranging from a few days to several weeks. For this reason, parents looking to adopt newborn infants find more success domestically.

Parents adopting a child with HIV must also have an extra document signed, an I-601 waiver of inadmissibility from the U.S. Citizenship and Immigration Services (USCIS). People with a “communicable disease,” such as tuberculosis and HIV, as defined by the Centers for Disease Control and Prevention (CDC) are required to have this waiver, since they are currently ineligible to receive a visa under the Immigration and Nationality Act.

The I-601 waiver must be processed by the CDC, the state department, and the USCIS, and previously took from three to nine months to process. The waiver currently should take no more than 10 days to process, according to J. McLane Layton, founder and President of Equality for Adopted Children (EACH).

Layton is currently advocating for the waiver to be completely eliminated, which hopefully will take place in the next few years. However, earlier this year, an amendment was proposed that would lift the ban of HIV-positive individuals entering the country, at which time people with HIV could be eligible for a visa and therefore would not require the I-601 waiver (related Beacon news).

EACH is a non-profit organization that works to promote adoption polices and legislative changes to ensure that adopted children have the same legal rights as biological children in the U.S.

“When families adopt internationally, the government treats that child as an immigrant, not an American,” Layton said. “We [at EACH] are a voice for adoptive children and families on Capitol Hill.”

Another delay that adoptive parents may face relates to new tuberculosis (TB) protocol issued by the CDC in 2007.

New testing and treatment rules have been established for immigrants older than 2 years of age, including those adopted by U.S. citizens. The protocol went into effect in April in Ethiopia and in July in China, two countries that have been frequently utilized by U.S citizens seeking to adopt.

This protocol, which includes a positive TB skin test, has affected non-HIV and HIV children being adopted from these countries. Upon receiving a positive result, the child is required to have mucus from the lungs cultured, the results of which typically take eight weeks to return.

According to Layton, in most instances, the TB positive skin test is determined after the child has already been adopted and is waiting to travel to the U.S. However, the adopted child cannot enter the U.S until the results of the test have been returned.

About two weeks ago, after much media attention on this issue, the CDC issued an addendum to this protocol. If a child 10 years of age or under has a positive TB skin test, a mucus culture from the lungs is still required. However, while waiting for these results to return, if the mucus specimen is examined under a microscope and found to have no mycobacterium tuberculosis (the bacteria that causes TB), the child may travel to the U.S. The results of this rapid test take about three days. If it is negative, the child can immigrate into the U.S.

Success Stories

Both Fleming and Layton have also found success in their own lives with adopting international children. Fleming recalls the scene when she adopted her daughter with HIV from an orphanage in Vietnam.

“The women [at the orphanage] said to me, ‘Why do you want this baby? You don’t want her; you want a baby that is big and healthy.’ I told them, ‘No I want her,’” she said.

Fleming has adopted several other children, including three that have HIV. Her one son was one of four children born with HIV in Chicago that year. She says all of her children are nothing but delightful. Fleming has been open with her church, her children, and neighbors about her three children’s HIV status. However, she has not felt the least bit of discrimination from anyone in her community.

All of her children play, share drinks, and interact with each other just as any other siblings would do. The only restriction they have is to not touch any blood from their siblings with HIV. Fleming said that, besides giving her children with HIV their medicine daily, they are able to live fully normal lives.

“Raising a child with HIV is often less work than caring for a child with juvenile diabetes,” Fleming said.

Layton has also adopted three siblings from an orphanage overseas, which inspired her to advocate for child adoption laws.

“If you want to make a big impact in the world, this is something to do,” Layton said.

Chances by Choice encourages families to look into adopting children with HIV. For more information about adopting HIV-positive children, visit the Chances by Choice Web site.

For individuals needing advice or having problems with the I-601 waiver form, visit Equality for Adopted Children.

Please see Part 1 of this series, “AIDS and Adoption – Part 1: Can I Adopt If I Am HIV-Positive?” which discusses adoption if you are HIV-positive.