Pediatric acquired immunodeficiency syndrome. Barriers to recognizing the role of child sexual abuse
L. T. Gutman, M. E. Herman-Giddens and R. E. McKinney Jr
Department of Pediatrics, Duke University Medical Center, Durham, NC.
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.
