The number of young people with perinatally acquired HIV is growing significantly. With antiretroviral drugs, children who get infected at birth with HIV have an opportunity to graduate into adolescence and adulthood. This achievement notwithstanding, new challenges have emerged in their care and support needs, the most dynamic being their sexual and reproductive health needs and rights (SRHR). This paper aimed to establish the gaps at policy, program, and health systems levels with regards to addressing sexual and reproductive health needs of young people who have lived with HIV since infancy. The paper is based on a desk review of existing literature on sexual and reproductive health needs and rights of young positives. The results indicate young positives are sexually active and are engaging in risky sexual encounters. Yet, existing policies, programs, and services are inadequate in responding to their sexual and reproductive health needs and rights. It is important that policies be formulated that specifically target this subgroup, and that such policies result in programs and services that are youth friendly. It is also important that integration of sexual reproductive health and HIV services is prioritized.