Background: Youth experiencing homelessness (YEH) face heightened risks of engaging in survival sex-exchanging-sex for basic needs due to intersecting individual, interpersonal, and structural vulnerabilities. While previous research has documented individual risk factors, less is known about how broader social determinants shape these behaviors. Method: This study utilized cross-sectional survey data from 205 YEH (ages 18–34) recruited from community-based sites in the Phoenix metropolitan area in 2022. Four hierarchical logistic regression models were used to examine associations between trading sex for survival and a range of demographic, sexual behavioral, health-related, and socioeconomic and living environmental variables. Findings: Overall, 25.5% of participants reported ever engaging in survival sex. Across all models, identifying as female and LGBTQ+ was consistently associated with higher odds of survival sex. Early sexual initiation, online sexual encounter, substance use disorder, and higher depressive symptoms were also significant risk factors. Conversely, having a high school diploma, sufficient income, and access to needed support services were protective. Conclusion: The findings underscore the complex correlations of gender, sexual orientation, behavioral health, and structural disadvantage in shaping survival sex among YEH. Interventions should address not only individual risk but also the broader social and economic context to effectively reduce vulnerability.