Because HIV infection is so serious, and children and adults alike are more prone to other infections, keeping a child strong and healthy is very important. And because children do not have the same reserves as adults, good nutrition is especially important for them. In poorer countries and in orphanages, where children oftentimes receive less than optimum nutrition, their bodies are further compromised and more prone to infection.
That is why in other countries, orphanages dedicated to the care of HIV positive children receive extra funding and attention so that the children can receive the extra medical and nutritional care that they need.
If you are considering adopting an HIV positive child, most likely you are adopting a child who is a true orphan and you will truly be giving a child the gift of life. We at Nightlight will be featuring children from Eastern Europe and Africa who are HIV positive. There are certainly considerations that need be taken before you and your family decide to adopt a child who is HIV positive and you will want to be well educated regarding HIV and AIDS in general and the issues you and a and HIV-positive child will face.
Another organization dedicated to the education and promotion of the adoption of HIV positive children is From HIV to Home.
Guidelines for when a Child Comes Home:
Bringing home a child who is HIV requires no special immigration or legal considerations. As of January 4, 2010, Health and Human Services and the CDC no longer require that visa applicants to be tested for HIV and if someone is HIV-positive that person cannot be found ineligible for visas based on HIV status. Therefore, children can enter the US who are HIV positive without a special waiver or visa.
Of course, a child who is HIV positive will need medical consideration. An HIV-positive child who has arrived home will need the same medical and developmental tests that other adoptees should have as well as care from a specialist
HIV infected children can receive powerful combinations of antiretroviral medicine to stop viral replication, and there are about 20 such antiretroviral medications. The treatment can, of course, be continuously changing based on the latest medical breakthroughs. These drugs have significant impact on the quality and life as well as the decreasing the rate of death. Before antiretroviral drugs, about 50% of HIV positive children lived to be 10 years old.  Here in the US, from 1998 to 2002 the Center for Disease Control and Prevention (CDC) reported a 68% reduction in deaths of children who were HIV positive.
Every child who is HIV positive needs to have a nutritional assessment, which includes growth history and body measurements, including percentage of body fat. In fact, head circumference should be monitored every three months for children 3 and under. A child’s head circumference should be within 40th percentile of the child‘s percentile for weight and length. Having a smaller head and body is not as problematic as a child’s having a normal height and weight yet a smaller head. (This is also true for non-HIV infected children.) Children also need blood tests that assess their hemoglobin and homatocrit levels, glucose levels, and cholesterol and triglycerides. In addition, the child or caretaker needs to state everything the child has eaten in the last 24 hours to determine if the child is getting enough calories, protein, and other nutrients. It is important to find out if the child is receiving any vitamins or other supplements. If the child cannot consume enough calories because of lack of appetite, then the caretakers should find creative ways to get more calories into the child, such as through high-calorie drinks and increased snacking. Children who are given megestrol, an appetite stimulate, will often gain weight.
Children who are HIV positive are often found to be deficient in vitamins and minerals especially the B vitamins, including B12, folate, vitamins C, E, A and selenium and zinc. (Of course even non -HIV infected children from poorer countries are often nutrient deficient.) Vitamins A, C, E and selenium and N acetlcysteine can be especially important as they can help protect against infections.
These children are also especially at risk for developmental delays, and in one study, about three-fourths of HIV infected children had serious developmental delays. And for children living in orphanages, the environment can further exacerbate these delays. Therefore the child may need to be evaluated by an occupational therapist so that interventions can be designed to help the child overcome developmental delays and to address any possible sensory processing issues (link to blog).
If you are considering adopting a child who is HIV positive, these are some of the steps that you will want to take.
- As with all adoptions, you will want to consider the resources that you have to parent a child with special needs. You need to become educated on HIV positive children, the treatment and prognosis. Be aware that with any adopted child, the child most likely has faced some neglect and possible abuse. You will want to also prepare yourself for the attachment and other emotional issues that any adopted children who has lived in an orphanage will face.
- Pray about this decision to adopt such a child. Of course all parents need to be considering God’s will regardless. Be sure that you are truly called to this.
- Check with your insurance carrier that they will cover an HIV positive child. By law any group insurance policy must cover pre-existing conditions of an adopted child. If you are on an individual plan, you must check with your state law to be sure that the plan will cover your child.
- Read blogs and talk with other parents who have adopted children who are HIV positive.
- Be prepared for some concern from families and friends when you share your desire to adopt such a child. Be armed with lots of positive success stories and pictures of happy and healthy children who are HIV positive.
- Secure a health care provider in your area that specializes in the treatment of HIV.
- Again, as with all adoptive parents you will need to have a homestudy completed that specifically approves you to adopt a child who is HIV positive.
- Consider the country from which you want to adopt and if you are eligible. Although there are lots of children who are HIV positive being photolisted, you may not qualify for that country’s program. Also, you may have to use a specific agency to adopt a specific child. The agency may not be a good fit for you.
- Select an agency that has a program in the country in which you are interested. Ask the staff if they will work with you in adopting a child who is HIV positive. As long as you qualify for a program, it should not be difficult to find a child who is HIV positive as adoptable HIV positive children are found in nearly every country in which children are being placed for adoption.
- Complete the Immigration and country paperwork (dossier) for the country in which you plan to adopt a child.
- Be matched with a child. Have an international adoption medical specialist and an HIV specialist evaluate the child’s medical record and photo so that you are fully prepared for your child’s condition. HIV positive children can have other health and developmental issues.
- Once matched with a child, you may then be able to provide extra medical care to your child, based on your child’s country program.
- Complete the adoption process and go to the US Embassy with your child to secure a US visa.
- Bring your child home.
- Have your child evaluated as any internationally child would be plus seen by a specialist who works with HIV and AIDs patients.