Sir.—The article by Gutman et al1 on human immunodeficiency virus (HIV) transmission by child sexual abuse in the February 1991 issue of AJDC can be misleading. The authors found that the incidence of sexual abuse among the 96 children who tested positive for HIV was 14.6%. The accepted incidence of sexual abuse in the general population is one in six, or 17%.2 If one were to examine any group of children for signs of sexual abuse, leukemia, or the common cold, one would expect to come up with a similar figure. It appears that HIV-positive children are at no increased risk of abuse.
I agree with the authors that it is important to identify those children who are HIV positive and have been sexually abused, because some immediate and delayed behavioral sequelae of child sexual abuse may put the child and adult survivor at increased risk of