The findings show a direct association between a history of childhood sexual abuse and a later high risk of HIV infection related to participation in the sex trade. A history of childhood sexual abuse predicted the subsequent exchanging of sex with other men for money or drugs; this relationship was partly accounted for by active drug use. Substance use in the context of sexual relations was also a key factor in predicting sexual behavior that increased the risk for HIV transmission. Interventions that focus on resolving issues of child sexual abuse are needed to improve the emotional well-being and mental health of survivors of sexual abuse. One target for such intervention should be men who exchange sex for money or drugs. Men attending a large gay pride event (n=647) completed anonymous surveys that assessed demographic characteristics, childhood sexual abuse, symptoms of dissociation, trauma-related anxiety, borderline personality characteristics, hopelessness, substance use, and risky sexual behavior. A latent variable partial least squares analysis was conducted in order to test the interrelationships among childhood sexual abuse, exchanging sex for money or drugs, emotional disturbances, drug use, substance use in the context of sexual behavior, and risky sexual behavior. The model fit the data well and accounted for 10 percent of the total variance in risky sexual behavior. 4 tables and 29 references