Consecutive intakes (N = 419) between ages 13 and 18 years to chemical dependency (CD) programs in a large private health plan were interviewed. The prevalence of six HIV risk behaviors was measured and categorized into zero, one, and multiple risk groups. The relationships between both demographic characteristics and substance use with HIV risk behaviors were examined. Approximately half the sample reported at least one risk behavior, with 17% reporting multiple risk behaviors. Those most likely to report multiple risk behaviors were heavy drinking boys, as well as girls who reported using narcotic analgesics. Implications of these findings for pediatricians and CD clinicians are discussed.