This study investigated the mechanisms of risk for urban women at high risk for HIV with and without childhood sexual abuse (CSA) histories. CSA survivors reported more unprotected intercourse and sexually transmitted infections (STIs). The association of STI locus of control with frequency of unprotected sex was fully mediated by being intoxicated during sex and engaging in sex work, whereas the association between relational control and unprotected sex was not mediated by contextual factors for the CSA group. The mechanisms of risk are different for those with divergent CSA histories and thus interventions should be developed to educate women with a history of CSA about ways to avoid revictimization, particularly within a context of poverty, prostitution, and drug use. KeywordsChildhood Sexual Abuse; Drug Use; Sexual Risk; HIV Risk; STI Risk Rates of childhood sexual abuse (CSA) among U.S. adult women have been estimated at anywhere between 14% (Bensley, Van Eenwyk, & Simmons, 2000) and 33% (Elze, Auslander, McMillen, Edmond, & Thompson, 2001). Women who are deemed to be at highest risk for sexually transmitted infections (STIs) including HIV (e.g., methadone treatment drop-outs, injection drug users, homeless women, female prisoners) have been reported to have even Address correspondence to Katie Mosack, Department of Psychology, University of Wisconsin-Milwaukee, PO Box 413, Milwaukee, WI 53201. NIH Public AccessAuthor Manuscript J Child Sex Abus. Author manuscript; available in PMC 2011 January 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript higher rates of CSA experiences than the general population (Kang, Deren, & Goldstein, 2002;Mullings, Marquart, & Brewer, 2000;Noell, Rohde, Seeley, & Ochs, 2001;Plotzker, Metzger, & Holmes, 2007;Sikkema, Hansen, Meade, Kochman, & Fox, 2009). Alarmingly, rates of CSA among women with HIV are estimated to range from 32% to 59% (Bedimo, Kissinger, & Bessinger, 1997;Gielen, McDonnell, Wu, O'Campo, & Faden, 2001;Simoni & Cooperman, 2000). Having experienced CSA has been associated with later risk behaviors, including having several sexual partners (Batten, Follette, & Aban, 2001;Hillis, Anda, Felitti, & Marchbanks, 2001;Johnsen & Harlow, 1996;Krahé, Sheinberger-Olwig, Waizenhofer, & Kolpin, 1999;Meston, Heiman, & Trapnell, 1999), having anal sex (Wingood & DiClemente, 1997), and failing to use condoms (Batten et al., 2001;Johnsen & Harlow, 1996;Meston et al., 1999;Noell et al., 2001). Additionally, women who have been sexually abused in childhood are at risk for subsequent sexual victimization as adolescents or adults (Arias, 2004;Johnsen & Harlow, 1996;Krahé et al., 1999;Lodico, Gruber, & DiClemente, 1996;Noll et al., 2003;Randolph & Mosack, 2006).Despite evidence indicating an association between CSA and adult sexual risk, causal pathways and mediators between CSA and STI risk have been understudied (Noll, 2005). Some research suggests that the long-term sequelae of CSA, including drug use and problems with sexual adjustment, likely m...

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