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 may 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, 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.

“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.

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