On the whole, child abuse practitioners are reluctant to consider HIV testing. Consequently, several attempts have been made to develop protocols for assessing the risk of HIV exposure during sexual abuse. Risk factors in the alleged perpetrator that might make HIV testing of the child more pertinent include known HIV infection, injecting needle-sharing drug abusers, origin from area of high HIV prevalence, multiple sexual partners, and bisexual practices. Information about the medical, social, sexual, and behavioral history of the perpetrator, however, is rarely made available to the sexual abuse team, making it difficult to base testing on perpetrator risk factors. A decision to test based solely on the type of abusive act is also fraught with difficulties, since children are usually too young or sexually inexperienced to describe the sexual abuse in any detail. A further difficulty in deciding whether or not to test for HIV infection is the anxiety of many child-protection case workers regarding the disease and their concern about upsetting the parents. It may be better to acknowledge the concerns, use counseling and listening skills with the family, and refer the family for testing. There is an urgent need for prospective studies on the risk of HIV transmission by sexual abuse. HIV surveillance data should include sexual abuse as a separate high- risk category. 19 references