Child Sexual Abuse and HIV/AIDS in Indian Country

He sits in the waiting room alone. No parent or adults have accompanied him. No magazine or video will occupy him while he waits. He has come here simply to tell his story to the FBI agent. An old shoe box sits on his lap. Later he will tell us that inside the box is a photo collection he found in his stepfather's camping box.

At 17, he drove his own car to the interview so he could speak about his experiences and seek help and healing. He was counting on the professionals, in a system he did not understand, to simply do the right thing. Isn't it a crime for your stepfather to sodomize you, take pictures of you dressing with a hidden camera, and to touch you in the middle of the night? He should have guessed how it would all come out; his stepfather had warned him. No one would believe or act on the story of a troubled Native gay teenager. After all, his stepfather was a teacher in the local school, and he had hired a criminal defense attorney the day he learned of his stepson's disclosure.

It's been four years since he told the agent his story. His stepfather has AIDS. There are days that he worries that he, too, is infected, but he does nothing. He still hasn't been tested and the thought of telling his story again keeps him silent. ¹

It is becoming apparent that children and adolescents who have been sexually abused are at risk for HIV/AIDS in two critical ways. The first and most recognized relationship between child sexual abuse and HIV/AIDS, which presented early in the AIDS epidemic, is that survivors of child sexual abuse are more likely than nonabused participants to exhibit high-risk HIV behaviors such as having a greater number of sexual partners, unprotected sex, use of intravenous drugs, an inability to negotiate condoms, and higher levels of unwanted sexual activity and prostitution. Second, it has been found that this at-risk population exhibits high rates of sexually transmitted diseases that place them at even further risk for infection.

The presence of an STD in a child has other implications as well. Sexually transmitted diseases indicate that a child or adolescent may have been involved in wanted or unwanted sexual activity. Detection of a sexually transmissible agent in children over one month of age should raise concerns of sexual abuse. Although the presence of an STD in a child is often suggestive of sexual abuse, it is important to note that there are exceptions and that caution must be preserved. A thorough examination of the child is necessary because "rectal and genital chlamydia infections in young children may be due to a persistent perinatally acquired infection, which may last for up to 3 years." ² The implication is that the presence of an STD may indicate the transmission of HIV/AIDS in sexually abused children, which is the major concern addressed in this essay.

The relationships between HIV/AIDS and child sexual abuse in Native children and adolescents are a rising concern among those working in these fields. After many informal and concerned conversations between the authors, who specialize in HIV/AIDS and child abuse in Indian Country, they began to discuss the vulnerabilities of Native people to infections and abuse and noticed not only the differences in the rates of HIV/AIDS and child sexual abuse, but also how these two issues were closely tied together. Driven by their worry and desire to inform a larger audience about the dangers of HIV/AIDS and child sexual abuse, and to promote further efforts in these areas, this article emerged.

The scant literature on the relationship between child sexual abuse and HIV/AIDS as well as information...