Childhood sexual abuse has been linked to high-risk sexual and drug-taking activities and HIV/AIDS, particularly among women. Using self-report data from a sample of 1,198 newly incarcerated female offenders, this study examined the relationship between various contextual factors related to the onset of substance use and HIV-related risky behavior. The early life events of inmates that report childhood sexual abuse was compared to those that were not sexually abused. The relationship between child sexual abuse and the onset of substance use was explored. Models determining whether childhood sexual abuse has independent effects on later HIV risk-taking behavior, while controlling for other early negative life events, were developed. The differences in perception of HIV risk and self-reported need for prison-based treatment (addressing issues of HIV drug and sexual risk-taking behavior) among women prisoners that were sexually abused during childhood compared to nonabused inmates were also explored. The data were compiled for the Texas Commission on Alcohol and Drug Abuse by the Texas A&M University, Public Policy Research Institute through face-to-face interviews with a sample of women prisoners incarcerated between May 1998 and March 1999. Approximately 1,377 newly admitted females were asked to participate, and 1,198 completed the interview, yielding a response rate of 87 percent. The research demonstrated significant differences in the accretion and cumulative effects of these factors among prisoners reporting childhood sexual abuse compared to nonabused inmates. Female prisoners with histories of childhood abuse and drug use represent a special-needs population whose treatment needs exceed traditional prison-based drug programming. There must be a link between prison and community-based drug treatment programs. Early victimization appears to contribute to a trajectory or life course that is associated with drug abuse and high levels of risk taking in adulthood. A history of childhood sexual abuse should be considered when designing intervention programs to reduce HIV sexual risk-taking behavior among female inmates. 1 figure, 5 tables, 54 references