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The purpose of this study was to describe mental health symptoms in a sample of 66 HIV-positive youth (ages 16–25) and to evaluate social support, disclosure, and physical status as predictors of symptoms. Data were collected from January 2002 to May 2003. As measured by the Brief Symptom Inventory (BSI), 50% of the youth scored above the cutoff for clinically significant mental health symptoms, thus highlighting the need for mental health services. Lower social support, higher viral load, HIV-status disclosure to acquaintances, and being gay/lesbian/bisexual (GLB) were all significantly correlated with more mental health symptoms, but disclosure to family and close friends and contact with service providers were not. Furthermore, regression analysis showed that social support, viral load, and disclosure to acquaintances predicted 32% of the variance in mental health symptoms. Being GLB was no longer significant, most likely because of shared variance with low social support. Results suggest the importance of mental health interventions, and the potential of social support interventions to improve mental health. Further research addressing the role of HIV-related stigma and homophobia is warranted.