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, 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.