By David Crary
The Associated Press
The immediate task might be coaxing a toddler into one more swallow of nasty-tasting medication. Longer term, there are tough choices to be made about telling that child - and the surrounding community - why those daily doses may be needed for the rest of his or her life.
While most adoptions present challenges, there's a distinctive set of them facing parents who decide to adopt children living with HIV. A twice-daily medication regimen. Prejudice and fear. Uncertainty about the child's longevity and marriage prospects.
Yet the number of U.S. parents undertaking HIV adoptions, or seriously considering them, is surging - from a trickle five years ago to at least several hundred. Most involve orphans from foreign countries where they faced stigma, neglect and the risk of early death.
"I can't think of a more significant way to make an impact than to do this," said Margaret Fleming, a 74-year-old Chicagoan whose nine adopted children include three HIV-positive first-graders.
"These kids were, in many ways, the modern-day lepers."
There are no firm figures on the number of HIV-positive adoptions in the United States, though adoption experts say most involve children from abroad because American mothers with HIV are usually able to avoid transmitting the disease by taking medication during pregnancy.
Ignorance and bias related to HIV haven't vanished in the United States. But the stigma is steadily lessening, especially compared with many of the other countries that are home to an estimated 2.5 million children with the disease.
At forums and over the Internet, parents who have adopted HIV-positive kids are offering advice and encouragement to those who might follow suit. In February, Bethany Christian Services - the largest U.S. adoption agency - unveiled a detailed educational package about HIV adoptions to help the growing number of interested parents make informed decisions.
"We didn't feel we could ethically place these kids without some really solid education for these families," said Sara Ruiter, Bethany's international services coordinator. "There are some very unique, chronic challenges that we want to be on the parents' mind."
One of the most difficult challenges, for many families, is deciding whom they will tell about the child's HIV status. Health care providers must be informed; otherwise, under federal and state confidentiality laws, it's entirely optional whether parents notify school officials, neighbors or anyone else.
As a result, families' approaches vary - some are totally open, while others guard the information so tightly that even the child may be kept in the dark for many years.
"Once your child's status is disclosed, you cannot 'take it back,' so careful consideration and thought should be given to this important issue," Bethany said.
For Tim and Annette Franklin, of Bridport, Vt., the decision to be open about their adopted daughter, Gedeleine, was intended to make clear it's nothing to be ashamed of.
"We were concerned that by being overly secretive, we would be contributing to the stigma," said Tim Franklin, a Congregational minister.
"Inevitably, in families where there are secrets, the secrets end up being destructive," he said. "We felt it's going to come out, and we want to control the way it happens, rather than it coming out in a bad way."
Gedeleine, who will be 4 in May, was living in a Haitian orphanage when a catastrophic earthquake struck Jan. 12, 2010. Already in the adoption pipeline, she was airlifted to Florida 11 days later with dozens of other children, then taken to her new home in rural Vermont.
There have been moments where Gedeleine balked at taking the twice-daily dose of three HIV medicines. But her parents, who have four biological children ranging in age from 8 to 19, say the adoption has been a heartwarming success overall, to the extent that they are now completing arrangements to adopt an HIV-positive boy from Ethiopia.
The arrival of 13-year-old Epherem will speed up the timetable for the Franklins to tackle one of the other distinct challenges of HIV adoptions - having frank discussions with the child about the impact of his status on any future sexual relationships, and the need to be honest with any partner.
"We'll have to find out what he knows about sexuality, what he knows about his disease, what values he's been exposed to," Tim Franklin said. "One of the things we'll try to help him understand is that he has a responsibility to other people."
Like the Franklins, Ryan and Stacy Vander Zwaag of Mears, Mich., have decided to be open about the HIV status of their 2-year-old daughter, Luisa, who arrived from Colombia on March 19. They even have a detailed section about HIV on the family blog.
"We did not have to tell anyone," the Vander Zwaags wrote. "But we believe God has given us this opportunity to educate others about the precious children like Luisa (and adults too) that are living with HIV and AIDS and help raise awareness and truth instead of ignorance and fear."
Luisa joined a household bustling with the Vander Zwaags' four biological sons, aged 5 to 13, and daughter Anaya, almost 4, who was adopted from Guatemala in 2008.
The boys were briefed in stages about their new baby sister - first being told she had a blood disorder, then getting the full story that she had HIV. There were specific instructions about precautions to take if Luisa bled from an open cut, but the overall message was one of reassurance that the disease can't be spread through casual contact.
Ryan Vander Zwaag, the youth pastor at a Baptist church, said he and his wife had talked about adoption ever since they married right out of high school. The more they learned about the vast numbers of HIV-positive orphans, the more interested they became in bringing one into their family. Fears about exposing their own family to health risks and prejudice gradually faded as they read articles, attended a conference, and spoke with other parents who had undertaken HIV adoptions.
"It's not that hard," said Stacy Vander Zwaag. "And there are so many kids who would die without it."
Luisa was in that category, her parents said. A doctor told them she would almost certainly have died soon had she stayed in the Colombian foster home where she was placed as an infant.
"She was removed from her parents because of medical neglect," Ryan Vander Zwaag said. "It was nothing she did. It was choices her mother and father made that got her infected with HIV."
The Vander Zwaags have been homeschooling their four sons, but they hope to place Anaya and Luisa in a nearby Spanish immersion school so the girls can be fluent in the language of their homelands.
So far, friends, neighbors and church members have been overwhelmingly supportive of the news about Luisa, but her parents said they know complications might await.
"As she goes through her teens and her dating years, there are going to be questions, and a lot of tears over it," Ryan Vander Zwaag said. "She'll have to find that right guy to walk with her through life. That will be challenging. She can live a full life, she can have kids, by being careful, taking the medicine."
CAPTION(S):
The associated Press
Tim, center, and Annette Franklin, right, celebrate Christmas 2010 with children Olivia, left, Elliot, Emma and Gedeleine, who is HIV positive. Gedeleine was adopted from Haiti.
mary ellen moody via the associated press
Ryan and Stacy Vander Zwaag, holding Luisa, who is HIV-positive, pose in Colombia with children Dylan, left; Jayden; Anaya, who was adopted from Guatemala; Easton and Spencer.
