Young people are faced with high levels of HIV/AIDS and unwanted pregnancy in South Africa. In this context it is important to understand the reproductive decision-making process with regard to these sexual risks. The study draws on in-depth interviews conducted with 20 Black students aged 18 to 24 years at the Walter Sisulu University. The study found that there was a high level of awareness of unwanted pregnancy and HIV/AIDS. However, many young people engaged in risky sexual behaviours. Differing gender roles seemed to significantly promote risky sex and discouraged shared decisionmaking. The study suggests that men often dominated the decision-making process. In addition, partner coercion was prevalent, and it negatively affected the health choices of young people. Other factors that were barriers to adopting prevention strategies included the negative attitudes of health providers and limited communication between parents and children and also, between sexual partners. Young people were afraid to freely discuss sexual issues and preferred actions to avoid antagonizing partners who might suspect infidelity, lack of commitment and HIV infection. Some young people also expressed concern that contraceptives were not safe. Young people emphasized the negative repercussions of HIV/AIDS and unwanted pregnancy and the importance of creating greater awareness of the risks and adopting prevention strategies. However, the study findings point to the need for health promotion interventions to go beyond risk awareness and incorporate the cultural, social and economic contextual factors in which the behaviour takes place.