Background: The disparity in rates of sexually transmitted diseases (STDs), HIV/AIDS, and unplanned pregnancy between Alaska Native (AN) and non-AN populations, particularly among young adults and females, is significant and concerning. Focus groups were conducted to better understand the knowledge, attitudes, and beliefs of rural Alaska youth (both AN and non-AN) and communities regarding STDs, HIV/AIDS, and unplanned pregnancy and to determine the best methods to educate and facilitate behavior change in AN youths regarding these issues. Methods: A convenience sample of AN and rural youth (n = 105) from 5 communities in Alaska, ages 15-24 years, participated in 21 focus groups. Focus group participants were divided by sex and age. We assessed themes related to knowledge, attitudes, and beliefs about STDs, HIV/AIDS, and unplanned pregnancy, as well as perceptions of how youths prefer to learn about sexual health issues. Results: The major themes identified were: (1) sexual health is not viewed only in relation to a physical act; (2) there is a basic understanding of sexual health, but youths have a lot of unanswered questions pertaining to STDs and HIV/AIDS; (3) sexual health messages should be delivered via the Internet and school; (4) youths want to hear messages promoting STD/HIV testing and condom use; (5) easier access to condoms is needed; (6) alcohol and drug use affect sexual behavior and risk taking; and (7) issues of confidentiality and embarrassment affect health care-seeking behaviors for sexual health issues. Conclusions: One of the fundamental principles of public health practice is community participation, which asserts that success in achieving change is enhanced by the active participation of the intended audience in defining their own high-priority solutions. Our findings--driven by youth themselves--are critical in designing and implementing future sexual health interventions and promoting greater community involvement and acceptance. (Contains 1 table.)