Pediatric acquired immunodeficiency syndrome. Barriers to recognizing the role of child sexual abuse.

The only reportable exposure categories for human immunodeficiency virus (HIV) infection of children are vertical transmission from an HIV-infected mother or receipt of infected blood or blood products. Although sexual transmission of HIV among adults is the subject of intense concern, sexual transmission of HIV to children during child sexual abuse has received almost no investigative attention. This review discusses factors contributing to the exclusion of sexual transmission of HIV to children from studies of the epidemiology of HIV infection. Difficulties occur in screening and confirming abuse in nonselected populations of children, perceived and real barriers exist to the evaluation for HIV of sexually abused children, and problems occur in the assessment for child sexual abuse of HIV-infected children. Impediments to the understanding of the relationship between sexual abuse and HIV infection in sexually abused, HIV-infected children are considered, and measures that can allow these barriers to be overcome are discussed.