Background: The purpose of this secondary data analysis was to determine the prevalence of sexually transmitted and blood-borne infections (STBBI) and to examine the role of survival sex in sexual risk among street-involved youth in Winnipeg, Manitoba. Methods: Between 1999 and 2003, 743 Winnipeg street youth were interviewed in three separate cohorts as part of a national multi-centred study by the Public Health Agency of Canada. Results: Among the 673 Winnipeg street youth who responded to questions relating to survival sex, 26.3% reported they had engaged in survival sex. Females and Aboriginal youth were at greatest risk for sex trade involvement. Youth engaged in survival sex were diagnosed with significantly higher rates of STBBI; experienced greater amounts of abuse; and were at greater risk for participating in high risk sexual behaviours compared to their non-sex trade counterparts. Conclusion: Gender specific, culturally appropriate, and youth oriented prevention and intervention strategies are urgently required to reduce the prevalence of STBBI and survival sex among this at-risk population.