Child Sexual Abuse and Human Immunodeficiency Virus Transmission-Reply

In Reply.—Dr Monteleone has made several points worthy of reply. First, he notes that the incidence rate of sexual abuse in the general population is 17%. Studies that lead to prevalence rates of that level define sexual abuse broadly (a definition we endorse). However, many of the abusive activities are only minimally physically invasive, such as viewing, fondling, kissing, rubbing, photographing, and so forth. These activities would not cause the traumatic injuries that resulted in the genital physical findings that were described in 13 of the 14 children in the present study. This is in contrast to the situation for the majority of sexually abused children in whom significant physical findings resulting from the abuse are not found. Therefore, compared with other groups of abused children, and as was noted in the original article, the abuse of the children in our study was unusually severe. We were not prospectively