[sak9645]

1. HIV is one of a list of "excludable" conditions defined by U.S. immigration law. A person with an excludable condition -- whether adopted or non-adopted -- cannot get a visa to enter the United States in MOST cases.

HOWEVER, there is a waiver process that has been used successfully to bring at least a few HIV+ children to the U.S. Basically, to get a waiver, you must prove to the satisfaction of the U.S. government that:

a) The person applying for a visa will not infect others in the U.S; and,

b) The person will not become a public charge (receive public assistance).

In general, to address the first issue, people wishing to bring an HIV+ child to the U.S. should be able to demonstrate, to the satisfaction of the USCIS, that they have a solid understanding of the disease and its transmission. They must satisfy USCIS concerns by having a "game plan" for preventing their child from infecting others.

It seems from my limited observation that the people who are most likely to get a waiver to bring an HIV+ child to the U.S. are those who work in health care, especially if they deal with HIV issues. It is fairly easy for them to make the case that they know enough about the disease that they can prevent its transmission, and to be able to educate their children in areas such as infection control and safe sex. However, there may be other people who can also make a compelling case -- for example, people who have adopted other HIV+ children, who have a close relative living with HIV, etc.

As to the issue of not becoming a public charge, the USCIS will be looking for:

a) Income that is well above average now and that that is likely to remain high in the future; and,

b) Access to extremely good insurance.

It is assumed that a child with HIV could potentially require a lot of health services over his/her lifetime, especially if his/her disease progresses to AIDS, and that the parent may well have to pay for such services, even after the child reaches adulthood.

As far as insurance goes, the parent will, at minimum, have to have GROUP insurance. Federal law mandates that a child whose parent has group insurance must be covered from the date of adoption or placement for adoption, with no exclusions or delays for pre-existing conditions. Except in a few states, where state laws extend such provisions to children covered by individual policies, insurance companies can decide not to insure a child at all, to exclude certain conditions from coverage, or to impose various waiting times for coverage, if he/she is under an individual policy.

Of course, even if a child is covered by a group policy, the specific provisions of the policy may or may not be favorable, and the USCIS will want to know about them. As an example, not all policies cover prescription drugs, and even those that do may exclude certain categories of pharmaceuticals, such as those that are experimental or far outside the norm in price. The antiviral drugs that are used to keep HIV from progressing to full-blown AIDS are costly, and some may be considered experimental.

Under certain conditions, a person with a serious medical condition and limited funds can be entered into a clinical trial at a place like NIH. The good news is that the person in a clinical trial will receive free medical care for his/her specific condition, and whatever medications are part of the trial.

The bad news is that, while some of the trials focus on testing drugs that are already in common use, with a good track record, many focus on drugs that are still in the early stages of testing in humans. You may or may not want your child in the latter sort of trials, especially if he/she could be helped by more conventional treatments. Also, there is no guarantee that a clinical trial of medications relevant to your child's particular situation will be going on when he/she needs care.

In short, it is not easy to get a waiver, but it is not totally impossible.

You really need to think about your ability to convince the USCIS that you have the knowledge and resources to care for an HIV+ child.

One thing you should do is to read every word of your health insurance policy. If you don't understand something, talk to the insuror or an expert on health insurance. Make sure that you understand the rights of adopted children under federal law and the laws of your state.

And you should arm yourself with as much knowledge as possible about the resources available to HIV+ children as you can. One way to get such information is to join organizations of families parenting HIV+ kids, whether or not they are adopted. These families will be a terrific source of information on free or low-cost care, as well as on other topics.

If you decide that you want to try to adopt an HIV+ child overseas, by all means pick an agency that is very familiar with such matters.

For one thing, in the normal international adoption process, you complete an adoption in the childl's country, and THEN go to the U.S. Embassy in that country with your child to file paperwork to obtain a visa for him/her. This is NOT a good way to proceed when you are trying to adopt an HIV+ child. You could well wind up with a child for whom you are legally and morally responsible -- but who cannot receive a visa to enter the U.S.

An agency with experience in bringing home kids under waivers should be able to tell you not only whether your situation is likely to qualify you for a waiver, but also how to avoid such a heartbreaking situation.

Best wishes to you as you consider adopting a child with HIV. Today, in the U.S., it is becoming increasingly common for people to live for many years with HIV, if they receive appropriate medical care. You could truly save an overseas child's life, if you were able to raise him/her in this country.

Sharon