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 might 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, lingering prejudice and fear and uncertainty about the child's longevity.
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," she said.
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.
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."
Ryan and Stacy Vander Zwaag of Mears, Mich., have decided to be open about the HIV status of their newly adopted 2-year-old daughter, Luisa, who just 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 write. "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."
THERE ARE NO FIRM figures on the number of HIV-positive adoptions in the U.S., though adoption experts say most involve children from abroad because American mothers with HIV are usually able to avoid transmitting the disease to their babies by taking medication during pregnancy.
Throughout most of the AIDS epidemic, only a handful of HIV-positive children came to the U.S. because of immigration policies that limited entry for anyone with the disease. In January 2010, that restriction ended enabling children with HIV to enter as easily as other adoptive children."