The purpose of this study was to investigate the relationships among self-efficacy for condom use during distress (SE-Condom Distress), self-efficacy related to general HIV prevention skills (SE-HIV), and HIV risk behaviors, attitudes, and knowledge. Two hundred and twenty two adolescents with psychiatric disorders between 13 and 18 years-old participated. Participants completed measures related to HIV Self-Efficacy, HIV Attitudes, and Sexual Behaviors. Self-efficacy for condom use during distress (SE-Condom Distress) was significantly associated with more HIV protective behaviors. Controlling for observed covariates, SE-Condom Distress was the only variable significantly associated with consistent condom use in a multiple logistic regression (OR=2.43). Self-efficacy regarding condom use during affective arousal is closely associated with HIV-related attitudes and behaviors. Clinicians need to be alert to subtle signs of distress as adolescents contemplate safer sexual behavior.