HIV Transmission and Childhood Sexual Abuse

To The Editor.  —The recent editorial entitled "Facing the Complex Issues of Pediatric AIDS: A Public Health Perspective" by Drs Osterholm and MacDonald¹ poses several unanswered questions, including "How do we deal with potential HIV [human immunodeficiency virus] transmission associated with child sexual abuse?" We recommend including questions about child-molesting behavior and potential as part of the routine evaluation and counseling of adolescents and adults who are seropositive for HIV. Physicians can then intervene prospectively and prevent needless infection and death of youngsters.Child sexual abuse is a serious, albeit often ignored, public health problem that is on the increase. Physicians tend to overlook or deny child sexual abuse, although 5% to 60% of adults recall sexual victimization during childhood.² At least 250 000 cases of child sexual abuse are reported annually³; however, most sexually abusive acts are never reported.Recent research indicates that a single child