African American men who have sex with men and who do not identify as gay are at high risk for HIV infection. This paper presents the results of the photovoice component, a participatory action research method, of a two-tiered qualitative study design that explored the perceptions of non-gay identified African American men who have sex with men living or working in the San Francisco Bay Area regarding the social, cultural, community, and family influences associated with their HIV risk and their general sexual health. Major themes that emerged from the photographs and discussions fell into three main categories: (1) The importance of a black identity, (2) factors inhibiting HIV prevention, and (3) factors that maintain health or promote health. Through their photographs, the men in this study explored the challenges and difficulties associated with maintaining their sexual health, in addition to describing the health promoting factors that reinforce wise choices in their everyday lives.