Little is known about the behavioral risks for both human immunodeficiency virus (HIV) and unintended pregnancy among sexually active youth attending voluntary counseling and testing (VCT) in developing countries, and whether youth engaging in risky sexual behaviors perceive themselves to be at risk for HIV. Data are from two cross-sectional studies with youth VCT clients in four facilities in Dar es Salaam, Tanzania and five facilities in Port-au-Prince, Haiti. We measured risky behavior for HIV and unintended pregnancy and perceptions of risk among VCT clients who reported ever having had sex. The majority of sexually active clients, 69% of men and 62% of women in Haiti and 65% of men and 60% of women in Tanzania, reported recent risky behaviors for HIV. Clients also reported risk behaviors for unintended pregnancy: 15% of men and 53% of women in Haiti and 21% of men and 29% of women in Tanzania. The majority of clients with risk behaviors in Tanzania, but not in Haiti, perceived themselves at risk. Strategies to meet youth VCT clients' broader reproductive health needs and avoid any missed opportunities should be tested.