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Child and Adolescent Sexual Abuse History in a Sample
of 1,490 Women Sexual Partners of Injection Drug-
Using Men
Robert C. Freeman PhD a , Kathleen M. Parillo MA a , Karyn Collier BA a & Ryan W. Rusek MA a
a NOVA Research Company , Bethesda, MD
Published online: 21 Oct 2008.
To cite this article: Robert C. Freeman PhD , Kathleen M. Parillo MA , Karyn Collier BA & Ryan W. Rusek MA (2001) Child and
Adolescent Sexual Abuse History in a Sample of 1,490 Women Sexual Partners of Injection Drug-Using Men, Women & Health,
34:4, 31-49, DOI: 10.1300/J013v34n04_03
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Child and Adolescent
Sexual Abuse History in a Sample
of 1,490 Women Sexual Partners
of Injection Drug-Using Men
Robert C. Freeman, PhD
Kathleen M. Parillo, MA
Karyn Collier, BA
Ryan W. Rusek, MA
ABSTRACT. Subjects for this study were 1490 community-recruited
women sexual partners of injection drug-using men who were inter-
viewed in three U.S. cities during 1990-’92. Data were collected on re-
spondents’ childhood and adolescent sexual abuse history, identity of
abuse perpetrators and duration of abuse. Over 56 percent of respondents
reported a history of sexual victimization by age 18, including 39 percent
who were abused before age 12 and over 53 percent who were victimized
by abuse involving bodily contact by age 18. One in three women were
victimized by unwanted penetration by age 18. White women more
likely than African-American and Hispanic women to have been the vic-
tims of virtually every type of abusive act investigated here. Overall,
nearly two out of three White women had experienced some form of sex-
ual abuse by age 18, including almost 42 percent who were the victims of
unwanted penetration by this age. Acts of forced sexual touching and
penetration occurring in childhood were most likely to have been carried
out by an uncle or other relative of the victim; family members were
much less likely to be the perpetrators of adolescent contact abuse. Based
Robert C. Freeman, Kathleen M. Parillo, Karyn Collier, and Ryan W. Rusek are af-
filiated with NOVA Research Company, Bethesda, MD.
Address correspondence to: Robert C. Freeman, PhD, NOVA Research Company,
4600 East-West Highway, Suite 700, Bethesda, MD 20814.
This project was supported by National Institute on Drug Abuse (NIDA) Grant No.
DA 10408-02.
Women & Health, Vol. 34(4) 2001
© 2001 by The Haworth Press, Inc. All rights reserved.
31

32
WOMEN & HEALTH
on these findings, it appears that many in this special population of
women are likely to be at substantial risk for some of the long-term ef-
fects of early life sexual abuse, including those that may reduce victims’
ability to take preventive action against HIV risk. Recommendations are
offered for those who function as caregivers to this population, including
drug treatment personnel. [Article copies available for a fee from The
Haworth Document Delivery Service: 1-800-342-9678. E-mail address:
<getinfo@haworthpressinc.com> Website: <http://www.HaworthPress.com>
© 2001 by The Haworth Press, Inc. All rights reserved.]
KEYWORDS. Sexual abuse, women, IDU sexual partners
INTRODUCTION
Sexual victimization in childhood is likely to have a significant im-
pact on victims’ interpersonal–including sexual–relationships in later
life (Finkelhor & Browne, 1985; Briere & Runtz, 1987; Brunngraber,
1986). For instance, a tendency among child sexual abuse (CSA) vic-
tims to become repeatedly involved in abusive relationships in adult-
hood (Alexander & Lupfer, 1987) may be related to a combination of
some of the direct outcomes of the initial betrayal, such as low self-es-
teem, impaired sense of efficacy and coping skills as a result of over-
whelming feelings of powerlessness, impaired judgment about the
trustworthiness of other people, or a desperate search for a healing rela-
tionship (Finkelhor & Browne, 1985; Johnsen & Harlow, 1996). In ad-
dition, to the degree that involvement in victimizing relationships,
chronic depression, and sexually compulsive behaviors–common adult-
hood characteristics of CSA survivors–may make it less likely that such
women will be able to successfully negotiate condom use with their
sexual partners, such individuals may be at substantially elevated risk
for acquiring the human immunodeficiency virus (HIV) through hetero-
sexual contact (Allers & Benjack, 1991; Zierler, Feingold, Laufer et al.,
1991; Cunningham, Stiffman, Dore et al., 1994).
Women who are sexually abused in early life and who subsequently
become the sexual partners of males who are, themselves, at elevated
risk–such as injection drug users (IDUs) (CDC, 1997; 1996; Neal,
Fleming, Green et al., 1997)–might well rank among those at highest
risk for HIV acquisition through sex. Although a growing body of re-
search has detailed the sexual abuse histories of adult women drug users
(Teets, 1995; Paone, Chavkin, Willets et al., 1992; Gil-Rivas, Fiorentine,

Freeman et al.
33
Anglin et al., 1997), relatively little is known about the early life family
experiences and abuse histories of women who, as adults, find them-
selves as sexual partners of injection drug-using men. As a result, little
can be said with any certainty regarding the severity and duration of any
early life sexual abuse experienced by such women, or whether they are
more likely to be victimized by strangers or persons known to them, or
whether such abuse history is likely to vary by victim’s race. In an effort
to address this gap in the research literature, this study examines–by
victim’s race/ethnicity–the prevalence, age of onset, and perpetrator of
specific types of childhood and adolescent sexual abuse reported by a
large (N = 1490) multiethnic sample of female sexual partners of male
IDUs recruited via community outreach in 3 U.S. cities.
METHODS
Subjects
Subjects in this study were participants in the National Institute on
Drug Abuse-supported Women Helping to Empower and Enhance
Lives (“WHEEL”) Project, a 3-year, multisite evaluation of an HIV
prevention model for noninjecting female sexual partners of male
IDUs. WHEEL participants must not have injected drugs in the year
prior to study entrance and must have had sexual intercourse with a
male IDU at least once in the previous 5 years. Recruitment methods
varied at each site, although community outreach workers typically
were involved in the process. All participants were randomized into ei-
ther a 1-session individual AIDS education intervention or into one
consisting of an individual session plus 3 AIDS education group ses-
sions.
Instruments and Measures
WHEEL interviewers used the Women’s Supplement (WS) to col-
lect data on women’s childhood and adolescent sexual abuse histories.
Acceptable test-retest reliability coefficients (.72 to .97) have been re-
ported for this instrument (NOVA Research Co., 1993). The WS probed
4 types of childhood (defined as age < 12 years) sexual abuse and 4
types of adolescent (ages 12-18 years) sexual abuse. Questions probing
childhood incidents were prefaced by the following instruction, read to

34
WOMEN & HEALTH
each respondent: Now I’d like you to think back to childhood (that is,
when you were 11 or younger) and remember if a relative, family friend,
or stranger ever made you do something sexual or touched you in ways
that made you feel uncomfortable. Next, respondents were asked whether,
during this period, anyone had ever forced them to observe their sexual
private parts or to reveal their own; talked “dirty” to them or shown
them “dirty” pictures, magazines, or videos; touched their body in a
sexual way or forced the respondent to touch their body in a sexual way;
or put their penis or another object into the respondent’s mouth, private
parts, or butt. For analytical purposes, the acts probed with the first 2
questions were categorized as instances of noncontact abuse; the latter
2 questions probe behaviors categorized here as contact abuse.
In investigating adolescent sexual abuse, respondents were first read
the following instruction: I’d like you to think back to your adolescence
(when you were 12 to 18) and remember if you had any sexual contact
that made you very uncomfortable or where the person was much big-
ger, stronger, or older than you were. Next, respondents were asked
whether, during adolescence, anyone had ever forced them to observe
their sexual private parts or to reveal their own; touched their body in a
sexual way or forced the respondent to touch their body in a sexual way;
tried to make them have sex; or put their penis or another object into the
respondent’s mouth, private parts, or butt. Again, for analytical pur-
poses, the first act was categorized as noncontact abuse and the latter 3
as contact abuse. It should be noted that the sets of questions used to
probe the childhood and adolescent abusive acts are not identical.
Respondents indicating victimization by one of these acts were asked
a series of follow-up questions concerning their age the first and last
time they were so victimized in that life stage and the identity of the per-
petrator (i.e., relationship to victim) the first time they were victimized
by that particular act in that life stage. Abuse perpetrators were catego-
rized as: (1) family member (father, mother, brother, sister, grandfather);
(2) aunt/uncle/other relative; (3) stepfather/stepbrother; (4) neigh-
bor/family friend (including family member’s boyfriend/girlfriend);
(5) teacher/social worker/other helping professional/clergy/police;
(6) boyfriend/girlfriend (including friend and other person you know);
and (7) stranger. Finally, in this report, duration of abuse was calculated
on the basis of victim’s reported age when a particular form of abuse be-
gan and age when it last occurred.
Data in this report were analyzed using standard statistical methods,
including chi-square for assessing significance of results for categorical

Freeman et al.
35
data and ANOVA for assessing significance of differences among con-
tinuous variables. SAS version 6.12 and SPSS version 8.0 for Windows
were used in all computations.
Sample
This analysis is drawn from WHEEL Project baseline participants
who resided in the 3 U.S. study sites (Boston, Los Angeles, and San
Diego) and who responded to all abuse history questions (N = 1,544).
The majority (67.3%) of these women identified themselves as Afri-
can-American; White women comprised slightly less than 20% of the
sample, Hispanics/Latinas made up 9.8%, and those of “other” race
made up the remaining 3%. Sample mean and median age was 32 years
(SD = 8.0). More than half (52.3%) of study women were single; more
than one-quarter were separated, divorced, or widowed; 12% were
married or living in a common law relationship, and about 8% were
living with a sex partner to whom they were not married (data not
shown).
To simplify analyses of abuse history across categories of race/eth-
nicity, data collected from self-identified racial “others” (N = 48), as
well as those collected from 6 respondents who furnished conflicting
answers to questions concerning abuse history, were deleted from the
analytical data file. Table 1 presents data on the sociodemographic
characteristics of the final study sample (N = 1,490) by racial/ethnic
group. Hispanic women were significantly younger (mean age = 28.4
years) than were the White and African-American women (mean ages =
32.5 years and 32.4 years, respectively); less likely to have a high
school education, to be homeless, to be divorced, or to live alone; and
the most likely to be homemakers, to be living with children under the
age of 18, to be living with a spouse, to be married, and to have a com-
mon law partner. African-American women were significantly less
likely than were the other women to be married and more likely to be
single, to be unemployed, and to be homeless. White women were sig-
nificantly more likely than non-Whites to have had at least some college
education; to be working full-time, and to be divorced, while they were
the least likely to be single and to have children under 18 years of age.
Overall, 88.9% of the sample reported a heterosexual orientation–7.8%
were bisexual and 3.1% described themselves as lesbians–while 92%
had been pregnant at some time in their lives (data not shown).

36
WOMEN & HEALTH
TABLE 1. Sample Characteristics by Race/Ethnicity.
Percent Reporting*
Characteristic
a
African-American
Hispanic
White
p
Highest grade of schooling
Less than H.S. graduation
H.S. graduate/GED
Trade school
.000
36.5
40.3
2.2
60.3
23.2
3.3
37.4
32.8
3.6
Some college
21.0
13.2
26.2
Marital status
.000
Single
57.3
5.2
4.7
7.9
12.8
9.7
2.4
--
44.7
14.7
8.7
9.4
13.3
8.0
.7
39.1
11.2
3.0
Married
Common law partner
Living with sex partner
Separated
6.9
16.8
20.1
2.6
Divorced
Widowed
Other
.7
.3
Has children <18 years of age
74.9
74.8
55.1
.000
b
Person(s) living with
Alone
10.2
5.9
4.0
14.0
13.3
43.0
28.5
64.9
9.3
7.9
.05
Spouse
.001
n.s.
Sex partner (not spouse)
Other adult family/friends
Other adults
14.0
41.8
25.5
53.5
13.6
27.5
40.9
34.8
.000
.000
.000
.000
Children <18 years of age
Current work situation
Unemployed; seeking work
Unemployed; not looking
Working full-time
Working part-time
On leave
40.8
18.1
2.7
29.8
19.2
6.0
25.9
18.6
8.6
7.6
1.3
7.6
4.7
--
5.9
10.6
2.0
1.1
Homemaker
8.6
13.9
6.6
Student
5.4
Retired
.2
--
Disabled
14.1
3.0
6.6
18.3
7.3
26.8
Other
5.3
Homeless
38.7
20.8
.000
c
1
2
1
Mean age (years)
32.4
28.4
32.5
*Percentages based on cases with complete data.
a
b
By chi-square.
Categories are not mutually exclusive.
c
Means with the same superscript are not significantly different.

Freeman et al.
37
RESULTS
Sexual Abuse in Childhood
Using the indicators employed here, 39% of study women were sexu-
ally abused before age 12 (Table 2).
Rates of contact and noncontact child abuse, as well as total child
abuse, differed significantly by race/ethnicity. Indeed, for every act in-
vestigated here except forced penetration, White women reported sig-
nificantly higher rates of victimization than did African-American and
Hispanic women. Over 45% of White women were sexually abused be-
fore age 12, and nearly 40% were victimized by at least one form of
contact abuse by this age. African-American women were the least
TABLE 2. Forms of Noncontact and Contact Sexual Abuse Reportedly Occurr-
ing in Childhood,* Total Sample and by Respondent Race/Ethnicity.
Type of Abuse
Percent Reporting
a
Total
sample
African-
American
Hispanic
White
37.7
p
A. Noncontact abuse
“During childhood, did anyone
ever force you to see their sexual
private parts or force you to show
yours?”
27.2
24.4
25.2
.000
.001
“During childhood, did anyone
ever talk dirty or show you dirty
pictures, magazines, or videos?”
17.6
31.9
15.3
29.0
19.9
24.3
Any noncontact abuse
32.5
36.0
41.3
39.1
.000
.015
B. Contact abuse
“During childhood, did anyone
ever touch your body in a sexual
way, including your breasts or
private parts, or have you touch
their body in a sexual way?”
32.9
30.6
“During childhood, did anyone put
their penis or another object in
your body, including your mouth,
private parts, or butt?”
16.7
17.4
11.4
16.8
n.s.
Any contact abuse
34.1
39.0
32.0
36.8
36.7
41.1
39.9
45.6
.029
.018
b
Any childhood sexual abuse
* “Childhood” defined as age 11 and under.
a
b
By chi-square.
Includes contact and/or noncontact abuse.

38
WOMEN & HEALTH
likely to report sexual abuse in childhood, although they were the most
likely to report being victimized by a penetrative act. Overall, more
women reported victimization by contact than by noncontact sexual
abuse before age 12, although slightly more White women reported
noncontact than contact victimization in childhood. Sexual touching,
reported by almost one-third of study women, was the most frequently
reported type of child sexual abuse.
Forced viewing of sexual private parts began at a mean age of 7.5
years, followed by forced penetration (7.6 years), sexual touching (7.7
years), and “dirty” talking or viewing of “dirty” images (7.9 years) (data
not shown). Among Whites, unwanted sexual touching began at a sig-
nificantly younger age (mean = 7.0 years) than it did for African-Amer-
icans (8.0 years), while White females reported victimization by forced
viewing of private parts at a significantly younger mean age (6.9 years)
than did African-Americans (7.8 years). Overall, mean duration of CSA
was 1.3 years, including 61.8% of abused women who reported a dura-
tion of < 1 year (including lone episodes of abuse). The mean duration
of victimization reported by White women (2.0 years) was significantly
greater than that reported by African-American women (1.1 years) and
Hispanic women (0.7 years) (data not shown).
CSA Perpetrators
Perpetrators of the 2 types of contact CSA did not differ significantly
by race/ethnicity (Table 3).
In the full sample, acts of forced sexual touching and penetration
were most likely to have been carried out by an uncle or other relative,
followed by neighbors/friends of the family. Hispanic women were par-
ticularly likely to identify uncles and other relatives as perpetrators;
White women were the most likely to identify a family member as the
perpetrator. Aunt, mother, and other female relative totaled < 1% of the
identified perpetrators of forced sexual touching (data not shown). The
gender of other types of perpetrators–e.g., family friend; social worker–
was not coded by the interviewer.
Sexual Abuse in Adolescence
Over 37% of sample women reported at least 1 instance of contact
abuse in adolescence and over 39% reported any kind of sexual abuse in
adolescence (Table 4).
Again, White women were significantly more likely to report victim-

Freeman et al.
39
TABLE 3. Perpetrator of First Incident of Childhood* Contact Sexual Abuse, by
Act and Respondent Race/Ethnicity.
Perpetrator
Percent Reporting
Total sample African-Am. Hispanic
A. Forced sexual touching
a
White
p
n.s.
Family member
15.5
36.7
4.2
14.0
37.8
4.9
11.1
44.4
1.9
21.6
30.2
3.4
Aunt/uncle/relative
Stepfather/stepbrother
Neighbor/family friend
Teacher/social worker/clergy/police
Boyfriend/girlfriend
Stranger
29.4
0.8
30.6
1.0
29.6
1.9
25.9
--
10.5
2.9
9.1
5.6
16.4
2.6
2.6
5.6
B. Penetration
n.s.
Family member
18.0
36.4
6.3
16.7
38.5
7.5
11.8
47.1
--
25.0
25.0
4.2
Aunt/uncle/relative
Stepfather/stepbrother
Neighbor/family friend
Teacher/social worker/clergy/police
Boyfriend/girlfriend
26.8
0.8
26.4
1.1
17.6
--
31.3
--
7.5
6.3
11.8
11.8
10.4
4.2
Stranger
4.2
3.4
* “Childhood” defined as age 11 and under.
a
By chi-square (4 empty cells in table).
ization than were Hispanic and African-American women (whose rates
were remarkably similar). The most often-reported form of adolescent
sexual abuse was attempted coercion into sex (over 31% reporting), al-
though rates did not differ significantly by race/ethnicity. However,
White women were significantly more likely than were other women to
report victimization by a penetrative act; indeed, nearly one-third of
White women reported being so victimized, compared to 22% of Afri-
can-American and Hispanic women.
Overall, forced viewing of sexual private parts in adolescence began
at a mean age of 13.9 years; forced touching of private parts began at a
mean age of 14.1 years, and attempted coercion into sex and forced pen-
etration began at a mean of 14.4 years (data not shown). Age of onset of
these acts did not differ significantly by race/ethnicity.

40
WOMEN & HEALTH
TABLE 4. Forms of Noncontact and Contact Sexual Abuse Reportedly Oc-
curring in Adolescence,* Total Sample and by Respondent Race/Ethnicity.
Type of Abuse
Percent Reporting
a
Total
sample
African-
American
Hispanic
White
30.2
p
A. Noncontact abuse
20.9 18.8
“During adolescence, did anyone
ever force you to see their sexual
private parts or force you to show
yours?”
16.6
.000
.000
B. Contact abuse
“During adolescence, did anyone
ever force you to let them touch
your body in a sexual way,
including your breasts or private
parts, or force you to touch their
body in a sexual way?”
27.2
24.8
25.3
36.1
“During adolescence, did anyone
try to make you have sex?”
31.5
24.2
30.4
22.0
28.5
21.9
36.7
32.9
n.s.
“During adolescence, did anyone
put their penis or another object in
your body, including your mouth,
private parts, or butt?”
.000
Any adolescent contact abuse
37.6
39.3
53.6
56.3
35.7
36.9
51.2
53.4
36.0
37.1
54.4
57.6
44.9
48.2
61.3
65.6
.012
.002
.007
.001
b
Any adolescent sexual abuse
c
Any early life contact abuse
b,c
Any early life sexual abuse
* “Adolescence” defined as ages 12 to 18.
a
b
c
By chi-square.
Includes contact and/or noncontact abuse.
Includes childhood and adolescence.
Combining reports of child and adolescent sexual abuse, over 53% of
this sample–including over 61% of White women–were victimized by
contact sexual abuse by age 18 (Table 4). Fully one-third of the full
sample–including 41.9% of White women–reported victimization by at
least 1 act of forced penetration by age 18 (data not shown). When acts
of noncontact sexual abuse are included, over 56% of study women
were victimized by at least 1 instance of sexual abuse by age 18 (Table 4).
Nearly 2 out of 3 White women (65.6%) were sexually abused by age
18; they were significantly more likely than were African-American
and Hispanic women to have been so victimized.
Study women were more likely to have been abused in both child-

Freeman et al.
41
hood and adolescence than to have been victimized in only one stage.
Over one-fifth of the sample (21.9%)–but almost 30% of White women–
were sexually abused in both stages (data not shown). By age 18, the av-
erage abused woman had been victimized for a mean of 2.5 years (me-
dian = 1 year), ranging from < 1 year to 13 years. The duration of abuse
reported by White women (3.8 years) was significantly greater than that
reported by African-American (2.1 years) and Hispanic women (0.9
years) (data not shown).
Perpetrators of Adolescent Sexual Abuse
Uncles and other relatives were not nearly as likely to be identified as
perpetrators of adolescent contact abuse as they were to be mentioned
as perpetrators of childhood contact abuse (Table 5).
Rather, boyfriends, generally followed by neighbors/family friends
and strangers, were most likely to be identified as perpetrators of ado-
lescent contact abuse. By and large, then, family members were much
less likely to be perpetrators of the first act of adolescent contact abuse
than they were to be involved in the first instance of childhood contact
abuse (see Table 3). For every type of contact abuse investigated here,
women from all 3 racial/ethnic categories were most likely to identify a
boyfriend as the perpetrator. No Hispanic woman attributed any of these
abusive acts to a stepfather or stepbrother, while between one-quarter
and 30.5% of White victims identified the perpetrator as a stranger.
Perpetrators of adolescent abuse varied significantly by victim’s race/
ethnicity only for acts involving penetration, where the proportions
identified as boyfriends ranged from less than one-third of African-
American victims to over half of Hispanic victims. Once again, females
comprised less than 1% of the identified perpetrators of contact abuse in
this life stage (data not shown).
DISCUSSION
Over 56% of the nearly 1500 female sex partners of male IDUs in-
vestigated here experienced at least 1 instance of sexual abuse by age
18, including 39% who were sexually abused before age 12 and over
53% who were victimized by contact sexual abuse by age 18. One in 3
women were victimized by unwanted penetration by age 18. Moreover,
over one-fifth of sample women were sexually abused both before age
12 and again between the ages of 12 and 18.

42
WOMEN & HEALTH
TABLE 5. Perpetrator of First Incident of Adolescent* Contact Sexual Abuse,
by Act and Respondent Race/Ethnicity.
Perpetrator
Percent Reporting
Total sample African-Am. Hispanic
A. Forced sexual touching
a
White
p
n.s.
n.s.
.05
Family member
8.0
14.2
3.6
6.9
17.5
4.1
7.9
13.2
--
10.7
6.8
Aunt/uncle/relative
Stepfather/stepbrother
Neighbor/family friend
Teacher/social worker/clergy/police
Boyfriend
3.9
23.5
1.3
26.4
1.2
23.7
--
16.5
1.9
29.7
19.6
26.4
17.5
36.8
18.4
35.0
25.2
Stranger
B. Attempted coercion into sex
Family member
7.1
10.5
2.9
7.3
13.0
3.3
4.7
9.3
--
7.6
3.8
Aunt/uncle/relative
Stepfather/stepbrother
Neighbor/family friend
Teacher/social worker/clergy/police
Boyfriend
2.9
22.3
0.9
24.7
1.0
20.9
--
16.2
1.0
34.8
21.4
32.3
18.3
44.2
20.9
38.1
30.5
Stranger
C. Penetration
Family member
6.1
10.4
2.0
6.9
13.3
2.3
3.0
9.1
--
5.2
4.2
Aunt/uncle/relative
Stepfather/stepbrother
Neighbor/family friend
Teacher/social worker/clergy/police
Boyfriend
2.1
18.4
1.2
22.5
1.4
15.2
--
10.4
1.0
38.3
23.6
32.1
21.6
51.5
21.2
47.9
29.2
Stranger
* “Adolescence” defined as ages 12 to 18.
a
By chi-square (6 empty cells in table).

Freeman et al.
43
The prevalence of early life sexual abuse reported here ranks toward
the upper end of the range reported in the research literature. For instance,
in the first national survey investigating CSA (Finkelhor, Hotaling,
Lewis et al., 1990), victimization–defined as either attempted/actual
sexual intercourse, unwanted touching or grabbing, acts of exhibition-
ism, or oral sex acts or sodomy before age 18–was reported by 27% of
adult women; in a community-based study of over 3000 adults (Siegel,
Sorensen, Golding et al., 1987), prevalence of childhood sexual assault,
defined as incidents involving pressure or force for sexual contact be-
fore age 16, was 5.3%. Indeed, the levels of early life sexual abuse un-
covered here have been approached only by those reported in a relative
handful of studies that have used similar nonprobability samples (e.g.,
Teets, 1995; Dembo, Williams, Wish et al., 1988; Rew, 1989) and in
even fewer that have utilized probability samples. Among the latter are
the investigations conducted by Russell (1983)–who found that 54% of
women in San Francisco reported history of intra- and/or extrafamilial
sexual abuse, including noncontact experiences–and Wyatt (1985),
who found that 62% of African-American and White women in Los An-
geles County reported history of sexual abuse prior to age 18. However,
40% of African-American and 51% of White women in the latter study
reportedly experienced contact abuse, each about 10% lower than the
corresponding figure in the present study.
White women were significantly more likely than non-White women
to have been victimized by all of the abusive acts occurring before age
12 investigated here except forced penetration. Over 45% of White
women were sexually abused in some fashion before age 12–nearly
40% were victimized by at least 1 form of contact abuse before this
age–while almost 42% reported at least 1 act of unwanted penetration
and over 61% reported some form of contact sexual abuse by age 18.
The finding of White women’s greater likelihood of victimization
supports the results of a number of studies that have used probability
samples (Siegel, Sorensen, Golding et al., 1987; Wyatt & Mickey,
1988; Browne & Bassuk, 1997), including national surveys (Cappelleri,
Eckenrode & Powers, 1993). Nevertheless, other investigators (Arroyo,
Simpson & Aragon, 1997; Urquiza & Goodlin-Jones, 1994; Teets,
1995) have found no significant differences in CSA prevalence by
race/ethnicity. While the present study’s large sample size increases the
likelihood of statistically significant between-group differences, the
consistency with which White women in the study reported–across the
various types of abuse investigated–greater frequency of victimization
than did non-White women is striking. That being said, the possibility

44
WOMEN & HEALTH
that these patterns might reflect a type of response bias cannot be ruled
out, for although all WHEEL interviewers were women, the matching
of respondents and interviewers along lines of race/ethnicity could not
be verified across all program sites.
In the present sample, respondents were more likely to report victim-
ization by contact than by noncontact abuse in both early life stages. In-
deed, about one-third of the sample reported unwanted sexual touching–
and about 17% unwanted penetration–before age 12; almost one-fourth
reported unwanted penetration during adolescence. The relative sever-
ity of this early life abuse may well have serious ramifications for later
life health behaviors among this population. While the long-term ef-
fects of CSA reportedly extend to depression (Rew, 1989; Gil-Rivas,
Fiorentine, Anglin et al., 1997; Lindberg & Distad, 1985), self-destruc-
tive behaviors (Gil-Rivas, Fiorentine, Anglin et al., 1997; Lindberg &
Distad, 1985; Greenwald, Leitenberg, Cado et al., 1990), feelings of
isolation (Brunngraber, 1986; Tsai & Wagner, 1978; Briere & Runtz,
1987), and low self-esteem (German, Habenicht & Futcher, 1990;
Brunngraber, 1986; McCauley, Kern, Kolodner et al., 1997), involve-
ment in HIV-risky sexual behaviors may be an important addition to
this list (Allers & Benjack, 1991; Zierler, Feingold, Laufer et al., 1991;
Cunningham, Stiffman, Dore et al., 1994). Already at risk for HIV/AIDS
as a result of sexual involvement with men who may be HIV-infected
through use of contaminated drug injection equipment, the women in
this sample would appear to be at substantially heightened risk to the
extent that abuse-related depression, low self-esteem, sense of power-
lessness, and/or impaired self-efficacy renders them less adept at nego-
tiating condom use with their partner or otherwise less capable of
adopting self-protective behaviors. Moreover, a number of studies have
suggested that adulthood posttraumatic stress disorder (PTSD) may be
a sequelae to CSA (Widom, 1999; Gil-Rivas, Fiorentine, Anglin et al.,
1997; Astin, Ogland-Hand, Coleman et al., 1995; Brady, Dansky,
Sonne et al., 1998), and PTSD may be linked to HIV-risky sexual be-
haviors as a result of, for instance, numbing of responsiveness (Miller,
1999).
Of added importance for the women in this sample are research find-
ings that indicate that CSA victims are at heightened risk for adulthood
drug use, possibly as a way of chemically dissociating from abuse-re-
lated psychic pain (Allers & Benjack, 1991; Johnsen & Harlow, 1996;
Gil-Rivas, Fiorentine, Anglin et al., 1997; Brown & Anderson, 1991).
Not only may drug use impair women’s judgment regarding use of pro-
tection (e.g., condoms) when having sex with high-risk partners, it also

Freeman et al.
45
is not uncommon for women who have extensive drug habits to trade
sex to support their drug use, thus extending their HIV risk. Indeed, the
fact that the women in this sample are recent sex partners of drug-using
men would appear to place them at particularly high risk for substance
use and abuse insofar as drug use may well have comprised the basis of
these relationships (MacRae & Aalto, 2000; Ouellet, Rahimian, &
Wiebel, 1998). Analyses of drug use in this sample presently are under-
way.
The strong prospect that women sex partners of male IDUs eventu-
ally will present at drug treatment programs suggests that it might be
profitable to utilize certain program approaches in attempting to reduce
their abuse-related HIV sexual risks. At a minimum, screening for
abuse history might be included as an important component of the in-
take process into care-providing programs. Logically, such a develop-
ment might be augmented by the hiring of staff trained in handling
abuse-related issues. Victims’ support groups, along with referral op-
portunities to specialized programs offering treatment for abuse vic-
tims, might be established as part of the service repertoire.
In addition, interventions specifically aimed at treating those effects
of the sexual abuse that may hinder adoption of HIV-preventive ac-
tion–for instance, programs to help participants overcome barriers in
negotiating the adoption of sexual risk reduction measures with one’s
partner–should be strongly considered. That being said, simple reliance
on such interventions to alter risk behaviors, without attempting to un-
derstand and change the unconscious processes and harmful behavior
patterns that stem from unresolved early life trauma, is likely to be of
limited effectiveness. Similarly, it should be cautioned that the optimal
temporal order of treatment for comorbid substance use and the ef-
fects/sequelae of sexual abuse-related distress–including PTSD–is in
some dispute. For instance, insofar as the substance use may be func-
tioning as a coping mechanism for dealing with abuse-related psycho-
logical distress, some patients may be unable to halt their drug intake
until alternative skills for dealing with trauma-related memories and
cognitions have been put into place (Root, 1989; Roesler & Dafler,
1993). Hence, treatment models that integrate the two approaches merit
consideration (Sullivan & Evans 1994; Triffleman, Carroll, & Kellogg,
1999).
The present analysis is limited in several ways. As these results were
gathered from a convenience sample, they cannot be generalized to
other samples. Reports of sexual victimization are particularly difficult
to corroborate, as retrospective data collection is subject to error from

46
WOMEN & HEALTH
memory fading and reconstruction (Gidycz & Koss, 1989). Loss of
memory about details of CSA typically is associated with younger age
of onset, a longer duration of abuse and injury during the abuse (Briere &
Conte, 1993). Moreover, as the WS probed only the first instance of
each type of abuse reported in childhood and adolescence, it was not
possible to ascertain the actual frequency of the abusive acts experi-
enced by study women. The age ceiling utilized here (i.e., 18 years)
means that some of the reported adolescent abuse might have been com-
mitted by individuals who ordinarily might be regarded as victims’
peers, although it should be noted that respondents had been instructed
to consider only those incidents that had made them “feel very uncom-
fortable or where the [other] person was much bigger, stronger, or
older” than they were.
Finally, it is extremely difficult to ascertain what role physical force
may have played in the execution of the acts investigated in the WS. For
instance, respondents were asked whether anyone had tried “. . . to
make [them] have sex . . .” in adolescence, and although a positive re-
sponse was categorized as an instance of contact abuse, the coercion in-
volved in many such incidents may more likely extend to persuasion or
psychological threat than to the application of direct force (Russell,
1983; Siegel, Sorensen, Golding et al., 1987). Nevertheless, acknowl-
edging interviewers’ introductory statement to this section of the ques-
tionnaire, it probably can be assumed that any incidents cited by
respondents are likely to have been ones that had made them feel dis-
tinctly uncomfortable at the time and/or were ones in which the aggres-
sor was clearly an intimidating presence, suggesting that the use of
force appeared as a distinct possibility.
Notwithstanding these limitations, the data reported here indicate
that high proportions of women sexual partners of male IDUs are likely
to have been victims of child/adolescent sexual abuse, particularly of a
contact nature. Caregivers to this relatively “hidden” population need to
be cognizant that many may be at substantial risk for some of the
long-term effects of such abuse, including those that reduce their ability
to take HIV-preventive action.
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