The whole world in her home

Are things still as bad as they were five or 10 years ago?

Progress has been made. The "3 by 5 Initiative" [an initiative by UNAIDS and the World Health Organization to get 3 million people in developing countries on anti-AIDS drugs by 2005], even though it failed to meet its target, still got hundreds of thousands of people on drug treatment. The Bill & Melinda Gates Foundation and the William J. Clinton Foundation are reaching tens of thousands of people with the actual drugs that you would get if you lived in Chicago or Las Vegas.

What's going to happen down the road a few years is that people will start to build up immunities to those drugs and need the second-line drugs, and those second-line drugs still have the high price tags on them. But we're not at that crisis yet.

You point out that one misperception Americans have is that we're a leader, in financial terms, in fighting AIDS and HIV. But though the United States does in fact give the most foreign aid money of any country in dollars (over $75 million between 2002 and 2005) -- it gives one of the lowest GNP percentages (0.1575 percent).

We're pathetic in that respect. And we don't know it about ourselves. We think that we're so generous and that we're holding up the world, but we're not.

You present a few theories about how HIV first spread, and you seem to favor the theory that, with the introduction of antibiotics to Africa in the 1950s, HIV spread through hundreds of thousands of unsterilized needle injections.

I found trusted experts who believe that is definitely the direction of the inquiry. But the force of the research now is behind finding a cure or a vaccine. There are not many people interested in how this happened. But it's also possible that the answer is so terrible, if it's truly the result of well-intentioned but misguided health campaigns. That's a tragic answer. And it's still going on.

There are regions where safe sex is increasing, condom use is increasing, sexually transmitted diseases are falling -- and HIV is off the charts. That's not explained by sexual behavior. One of the things people think is that AIDS is spreading out of control because of some African hypersexual behaviors. But researchers into sexual behaviors find African men have fewer lifetime partners than American men.

Was your goal in writing this book to move Americans to adopt an orphan themselves? To donate money? Or merely to be more aware of the situation?

I don't want to promote adoption as the major answer to AIDS in Africa because there's no way enough families around the world will open their homes to these children. That's doomed to failure.

I hope to be working against paradigm. The paradigm of Ethiopia is, People are starving and/or People are very fast runners. A lot of the major newspaper coverage begins with images like that. In Haregewoin Teferra, there's the story of a middle-class educated women whose husband was the high school principal and she too is suffering.

And on the most elementary level, I would love people to read this and think, "Oh my God, they're just like us! What's going on is as if my partner and I died and left our children orphans." The first step is to feel it as an emergency happening to people like yourself.

In the book you describe a white father from Vermont who wonders, when traveling with his wife to Ethiopia to pick up their new daughter, whether there's an imperialist angle to these adoptions. What's the answer to his question?

Of course one has mixed feelings looking at international adoption. You weigh what the child is losing: connection to culture and history and language and religion and art and literature. A child is losing the world into which the child was born. And that is almost always a loss. It's hard to offset that. A child is losing the right to grow up in a family that looks like the child, the child is losing the possibility of going out for dinner on a Tuesday night with his or her parents and not having people look over at the odd configuration of that family. It's not all good news, and the fact is that people can have incredibly happy and wonderful childhoods outside the U.S. In fact, on every trip I've taken into rural Ethiopia, I've had the same thought looking around, which is, if you could have enough food, schools and medicine, this would rival any childhood on earth -- the freedom of being out on this beautiful landscape and riding a donkey and chasing the geese and climbing a tree and running across the fields with your friends and swimming in a lake. It's a Huckleberry Finn childhood -- if there were food, medicine and schools. And parents.

But all of that is swept off the board when a child is orphaned in a poor country. Then you ask what can you do to make up for what the child has now lost? And what you can offer the child is a new family. And a new family trumps just about everything else. I can't imagine a child on earth who would rather be speaking their native language in the impoverished orphanage in Romania or Bulgaria or China or Cambodia or Vietnam or Ethiopia rather than learn English with a suburban family in, you know, Dallas. The tradeoff wins out.

It's a truism in the adoption world that people walking around with their adopted babies or children have observers come up and say, "She's so lucky, he's so lucky," and the adoptive mom or dad says, "No, I'm the lucky one." But what I've learned is that the true answer is, "You're right. This child has won the lottery. This is a lucky child."

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