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This study assesses the sexual and reproductive health (SRH) needs and barriers faced by youth living with HIV/AIDS in Lagos State, Nigeria. Conducted between September and December 2022, the cross-sectional survey involved 117 participants from HIV support groups, with a mean age of 18.6±2.6 years. Most participants were female (57.3%), and 47% had lost one or both parents. While 78.6% were aware of male condoms, only 33.3% reported being sexually active, and just 41% demonstrated good SRH knowledge. Key SRH needs included access to youth-friendly services, comprehensive education, diverse contraceptive options, support for HIV status confidentiality, as well as transportation assistance. Barriers to service utilisation were fear of HIV disclosure (66.7%) and transportation costs (59.8%). Sexual activity was significantly associated with contraceptive use (p=0.001) and being in a relationship (p<0.001). Regression analysis revealed that contraceptive use increased the odds of sexual activity 3.3 times (aOR 3.32, 95% CI 1.134-9.744, p=0.029), while being in a relationship raised it by 5.9 times (aOR 5.96, 95% CI 2.126-16.747, p=0.001). The findings underscore the need for targeted policies and programs to enhance access to SRH services and address the unique needs of youth living with HIV/AIDS in Lagos State., Competing Interests: The Authors declared no conflict of interest, (African Journal of Reproductive Health © 2025.)