Among adolescents (14-19 years) in Soweto, South Africa, 14% (4/29) who identified as lesbian, gay or bisexual (3 female and 1 male) reported living with HIV compared with only 2.3% (8/350) who identified as heterosexual (P = 0.002). These data indicate an urgent need to utilize evidence-based strategies to support access to HIV prevention education and services for lesbian, gay and bisexual youth.