Each sexually abused child was separately evaluated for each of the five possible routes of HIV transmission: vertical transmission, transfusion, clotting factor concentrates, intravenous drugs, and sexual abuse. In nine of the children, the modes of transmission were identified; four were through sexual abuse, three through vertical transmission, and two from HIV-contaminated blood transfusion. In six of these children, abuse was a possible source. Twelve males were identified or suspected of being perpetrators. Of these, three of the assailants knew they were HIV-positive, and eight were aware the child was HIV- positive at the time of the assault. There was no indication from any of the children that safe sex precautions had been observed. The evaluation indicated that children with HIV infections had multiple risk factors for abuse or neglect, whereas the sociological descriptors of the lives of the 14 abused children showed multiple know risk factors for or sequelae to the acquisition of HIV infection. These included drug abuse and alcoholism in the home, prostitution of a parent, lack of parenting, poverty, and chronic illness of the child. Prevention efforts should recognize that children as well as adults are at risk for sexually transmitted HIV infection. 2 tables and 43 references (Author abstract modified)