U.S. parents adopting a child with HIV from another country should know that the adoption process is very similar, but only differs when it comes to the immigration process. US law generally prohibits the issuance of a visa to people with HIV, however a person with HIV can apply for a waiver of inadmissibility, Form I601. The person or proxy person filing for a waiver of inadmissibility must provide documentation that the person with HIV will not be a "public charge" and that they will be under the supervision of a medical provider for their HIV. What happens in the case of adoption is that the family completes the adoption as any other international adoption, then completes the US immigration assessment of the orphan status of the child to be adopted. At the point that both of these are approved, the family applies for a visa, and this is the point that the child's visa application is denied. The family submits the I601 and supporting documentation (more to come on this!), it is sent for review by the CDC and ultimately approved by USCIS. Once the waiver of inadmissibility is approved, the family can apply for a visa on the child's behalf, and they can come to the U.S.!!

The HIV waiver is a form and supporting documents required to obtain your HIV+ child's visa, which is necessary for the child to come to the United States.
Instructions for filling out the form itself- (Make sure you have the current form I-601 which can be found at the forms page of www.uscis.gov)

Section A- "The applicant" is the child. Unless you already have your final adoption decree, leave this area blank. This information will be about the child being adopted, but the spelling of names, birth date, etc. must match the official documents exactly, so if you do not have the official documents when you are filling this out, leave it blank and you can fill it in later
Section B-This is information about the adoptive parent. If a married couple is adopting, use the parent's name that you listed as "the petitioner" on your I600A and I600 or I800a and I800.

This is information on the other adoptive parent. (If a single parent is adopting, leave this section blank). The second and third spots in section C can be left blank.

Sign, put relationship as "adoptive father" or "adoptive mother" and date.

Titled "To be completed for Applicants with Active Tuberculosis or Suspected Tuberculosis." Do not complete this page if your child does not have active or suspected TB.

Titled "To be completed for Applicants with Human Immunodeficiency Virus (HIV) Infection". *Make sure you have the form that says HIV on the top and NOT the one that is for applicants with Tuberculosis*
Section A- Since you are petitioning on behalf of your child, the applicant, the adoptive parent listed in Section B on the first page signs and dates this, and you should add "adoptive father" or "adoptive mother" after your signature.
Section B- This must be completed and signed by the doctor that will treat your child once they are home. The doctor you choose to fill out the waiver documents does not have to be the doctor that will treat your child long term, but you will have to take your child to at least one initial appointment with that doctor once they return home, to fulfill the waiver requirements.
Section C- This is completed and signed by the adoptive parent in Section A.
Section D- This must be completed and signed by your local health department (county, state, etc.)
You should fill out sections A and C, then have your doctor fill our section B, then have your public health office fill out section D. When you complete the I601, after the HIV specialist completes section B, a public health official completes section D indicating that this person has the requisite knowledge and experience to care for a person with HIV. You can find the person to complete this section of the form by talking with your HIV specialist, or by calling or looking at the web site for your city or county health department for the section of the health department that deals with communicable diseases such as tuberculosis. When you call this office, ask them who in this department completes paperwork related to immigrants and communicable diseases such as tuberculosis.

These are almost the exact same as the first 2 pages. Use the same directions.

Required "Supporting Evidence"
Evidence of applicant's relation to petitioner- You will need to add your final adoption decree to the waiver packet to fulfill this requirement. You do not need to do anything else for this requirement.
Evidence of petitioner's legal status in the United States- Your I171H proves your US citizenship and will be presented with your waiver. You do not need to do anything else for this requirement.
Letter from the Department of Health and Human Services, Center for Disease Control, indicating they do not object to the alien's admission to the United States- You do not need to do anything for this. The Consular Section initiates this letter from the CDC.

Letter from Insurance company- You need verification that the the insurance that you have will cover the child with HIV. All group health insurance plans should cover adopted children who are enrolled in care within 30 days of adoption/placement without any preexisting condition periods. You should try to obtain a letter from your insurance company that covers your family on their letterhead. The letter (or documentation from the insurance company) should clearly state that they will cover costs associated with extended hospitalization and medical treatment for the pre-existing condition of HIV infection. The letter must show that the child will be covered, and that HIV will be covered. Some families have had difficulty getting their insurance company to actually state that they will specifically cover HIV for legal reasons, even though they will. Families have gotten around this by having the letter from the insurance company state that the child will be covered in full from the date of adoption (or date of placement depending on the plan) and that there will be no exceptions for any pre-existing conditions. Photocopying pages from the insurance book stating such and showing HIV as a covered condition and photocopying the child's insurance card if you can get that, submitted along with the letter can also be helpful if the insurance company won't specifically mention HIV in their letter.

Additional supporting evidence: Please note–you are only required to provide the completed I601 and evidence that the child with HIV will not become a "public charge", however at one point it was suggested that it would be helpful additional documentation to provide the same information as is contained on the I601 (related to the parent's understanding of HIV on behalf of the child, the HIV provider, and the health department) in separate letters. Also, the whole question of what constitutes verifying that the child with HIV will not become a "public charge" is more complicated than just whether or not they have private health insurance. Private health insurance is the easiest way that the family can verify to USCIS that the child will not become a public charge, but not the only way.

Letter from applicant- Since your child will not be able to write a letter for himself or herself, the adoptive parents write this letter. The letter must state that the adoptive parents are aware of the child's HIV status, that they are aware of the potential dangers and risks HIV has for other people, that you are aware of the signs, symptoms, etc. and are educated and prepared to take all proper precautions, that you are very well educated on HIV and the care involved and required for parenting an HIV+ child and that you are committed to providing all necessary treatment and counseling that will be needed by this child.

Letter from physician- You need a letter on your physician's or medical care provider's letterhead saying that he or she is willing and prepared to care for your HIV positive child and that he or she is experienced in treating children with HIV. It should state that he or she is aware of the child's HIV status and is familiar with the course of treatment. The letter also must state that financial arrangements have been made in the event that extended hospitalization and medical treatment is necessary for the child's HIV, and what those arrangements are. (For example, the doctor might state that in the event that an extended hospitalization and/or medical treatment is necessary, your child would be covered by your family's health insurance plan, and the family would pay privately any and all deductibles.) *Your physician must give his full name, title, address and phone number. The physician that completes this letter should be the same physician that fills out section B on the supplemental waiver form.

Letter from Public Health Officer- This letter is not always necessary, but it has been requested of some families. In most cases, the signature and contact information of the public health official on the I-601 should satisfy this requirement. If you are obtaining an additional letter from the public health department, it should come from the public health office, whether county or local, that filled out section D on the waiver supplement. The letter should be on letterhead and should state that the physician you have chosen (to fill out section B and write the waiver letter) is familiar with the care of a child that is HIV+. The letter must state the name of department, the address and phone number. In order to find this person, if you look up your county's department of public health and contact their public health program office related to infectious diseases, TB, or HIV, you should be able to find a public health officer who can complete the form/ letter.

These letters should be dated and addressed to "To Whom it May Concern". They do not have to be notarized. There has not been any identified time frame of how recent they must be, but to be on the safe side, they should not be more than 6 months old at the time they are submitted at the visa appointment.

How Project HOPEFUL can help with families completing the I-601 waiver process for adopted children

The purpose of Project HOPEFUL's involvement in the HIV waiver process is to be a liaison to other people who are making sure that the waiver gets processed in a timely manner.

Previous to Project HOPEFUL's involvement, processing of the I601 was unmonitored and took up to 3-4 months after the embassy appointment. In the last year, the process has been reduced to 2 weeks (in Ethiopia), and in some cases, less.

We are working to increase the systematic processing of the I601s for adopted children in a consistently efficient way, and eventually HIV will be removed from the list of conditions requiring an I601 approval. It is still required though, and occasionally, things happen in many different parts of the process that can slow things down. These include holidays, technological communication breakdowns (missed faxes or emails on the part of various government offices), and other problems, including weather and political instability, that affect staffing in government offices in different parts of the world. Project HOPEFUL is not responsible for failures on the part of CDC or USCIS/DHS or the Department of State to receive and process paperwork in a timely manner.

Many families have been able to have a visa appointment early in the first week and travel on the Friday of the following week, however we strongly advise parents to schedule at least 10 business days post-embassy appointment prior to the scheduled departure and/or to have easily changeable tickets.

Please contact us and we will send you more detailed instructions as well as an authorization for the advocate who assists us with the waiver cases to be able to contact USCIS/ the State department on your child's behalf if your case encounters problems. There is no charge for any assistance from Project HOPEFUL or EACH, although we welcome donations to either organization.