This study utilized data from the National Longitudinal Survey of Youth to investigate youth risk trajectories for HIV and factors associated with different trajectories. The sample (N = 8,208) was 49.2% female, with a mean age of 14.31 (SD = 1.48). A group-based trajectory model was applied, which identified four distinct trajectories for both males and females: (1) consistently higher sexual risk levels, increasing to early adulthood followed by some decrease ("high"); (2) a short period of increase to late teens, followed by a longer period of decrease ("decreased"); (3) an initially slow increase, with the increase accelerating by late teens, and a slight decline beginning in early adulthood ("increased"); and (4) consistently lowest levels of sexual risk ("low"). More African Americans were found among the decreased trajectory group; among the low risk group a higher number of youth came from families with parents who spoke a language other than English. The high-risk group had a higher percentage of subjects in non-metropolitan areas and highest alcohol use. Among males, being employed and being in the military were associated with inclusion in the high-risk group. Results have implications for specializing prevention strategies for youth with different patterns of sexual risk.