Child sexual abuse is a risk factor for HIV transmission because the child is exposed to the bodily fluids of the perpetrator. In addition to such direct infection, sexually abused children may be at increased risk for future HIV infection because of the link between child sexual abuse and other high-risk behaviors for HIV infection in adolescence and adulthood. Available research suggests that child sexual abuse in SSA is at least as prevalent as it is elsewhere, and there are some indications that the prevalence may be increasing. In SSA, definitions of child sexual abuse should be expanded to encompass coercion or violence in early sexual relations and the practice of exchange sex or transactional sex. There is speculation that the perceived increase in child sexual abuse in SSA is linked to the spread of HIV, in that younger children are targeted by sexual predators who believe they are less likely to have HIV. Also, there is a widespread myth in the region that sex with a virgin, child, or daughter may cure HIV and other diseases. SSA has extremely high levels of HIV. Of the estimated 39.5 million people worldwide living with HIV, 24.7 million are in SSA. This review suggests a number of areas for future research. First, a large-scale empirical study of HIV infection resulting from child sexual abuse is required. Second, child sexual abuse as an indirect predisposing factor in HIV exposure should be explored. Third, high levels of coercion and violence in first/early sexual relations should be explored in qualitative studies that examine the extent of violence associated with early sexual relations. 33 references