African Americans have the highest rate of new HIV infection in the United States. This photovoice study explored the perspectives and experiences of African American female youth and sought to understand how adolescent development impacts HIV risk. This study used the photovoice methodology with seven African American or Biracial female youth, in Grades 8 through 12, residing in North Carolina. Study findings indicate that African American female adolescents struggle to navigate adolescence, specifically in coping with race- and gender-related stressors. The photovoice study demonstrated that African American early adolescent females face unique challenges that influence sexual health and HIV risk. There is a need for HIV prevention programs that support positive racial and gender identity development and teach early adolescents how to cope with race- and gender-related stressors. Our findings suggest it is important for youth to be sources of positive support for their peers.