Hiv is a major health risk problem as well as a source of distress in the gay community. In our investigation, we recruited 114 young men in Bologna who have sex with men in order to identify patterns and factors related to sexual risk-taking. Subjects completed a questionnaire assessing gay identity, perceived risk and social norms about Hiv, high-risk sexual behaviours and Hiv status. Results found a consistent prevalence of unprotected anal sex with steady partners in combination with low recourse to mutual testing. Psycho-social predictors of unsafe sex were beliefs about a diminished severity of Aids due to new medical treatments, poor personal knowledge of Hiv positive people, and lack of trust about safer sex. Aids prevention towards gay youth is challenging because of the difficulties in the interaction with social and health agencies, the lack of interventions in male sexualised settings and the dismissal of gay topics in public Aids policies. Effective health promotion approaches should take into account the social ecologies of gay youth through an empowering and community-based approach.