HIV/STD prevention that targets gay men seldom meets the needs of young men who have sex with men (YMSM). Some YMSM do not relate to gay-specific messages because they do not self-identify as gay. Many fear the social stigma and violence—sometimes intensified by culture and religion—directed at those identified as homosexual. Others identify themselves as bisexual and do not internalize gay-specific messages. On the other hand, HIV/STD prevention programs that target adolescents often exclude YMSM. This paper examines the challenges around preventing HIV in this population and provides guidelines for an effective, inclusive approach.