Professional paradigms within social work and related social service fields have been critiqued for being behaviorally focused, thereby obscuring and perhaps excusing structural determinants of health and well-being. Recent initiatives in international social work have aimed to align theory, practice, education, and research with sustainable development, reflecting the United Nations’ Sustainable Development Goals, which aim to address structural determinants. Our qualitative research examined responses to transactional sex among Ugandan youth through in-depth interviews with 23 professionals working in social services with youth who were vulnerable to HIV. Through thematic content analysis, using deductive and inductive analysis, we examined the demographics and determinants of youth transactional sex, prominent models of response delivered by and observed by providers, and the critiques or observed limitations of current practice models. We found that behavioral strategies are pervasive, which is an apparent misalignment with the economic determinants identified by social service professionals. While interviewees described some structural economic interventions, they critiqued gaps and limitations in responses influenced by internal and external pressures shaping professional practice. Our study adds critical analyses regarding social work and social service paradigms to advance structural, social justice-informed responses that align with and advance sustainable development.