This report describes the high prevalence and context of childhood sexual abuse (CSA) among Black men who have sex with men (MSM) across 3 independent qualitative studies. Semistructured one-on-one interviews were conducted with 87 Black MSM across 3 cities (Rochester, NY, n = 28; Lexington, KY /Atlanta, GA, n = 30; and Atlanta, GA, n = 29). A combined CSA prevalence of 32% (28/87) was found among the 3 samples, despite variation in geographic location, mean age, and sexual identification. Common themes emerging across the 3 samples included prolonged and repeated abuse by a close male relative; blaming of same-sex desire on CSA; and descriptions of adverse mental health reactions to CSA. Implications of CSA and its potential influence on the mental health and risky sexual behavior among Black MSM are discussed.