Building Trust Around HIV PrEP Through Peer Education

A Community-Based Peer Education Program for Reducing Stigma Around HIV Pre-Exposure Prophylaxis can help people make informed choices about sexual health without fear, shame, or assumptions. PrEP is a highly effective HIV prevention medicine for people who may have an increased chance of acquiring HIV, yet misinformation and social judgement can still discourage uptake and regular use.

In Australia, a practical program should connect peer educators with sexual health clinics, community organisations, researchers, and local health services. This approach aligns with the work of the health translation network to move evidence into services that improve outcomes for patients, families, carers, and communities.

Why PrEP stigma still matters

Stigma may appear as jokes, gossip, moral judgement, or the assumption that someone taking PrEP has many sexual partners. Some people worry that a partner, family member, pharmacist, or employer will discover their prescription. Others may confuse PrEP with HIV treatment or believe it encourages unsafe sex.

These concerns can delay testing, reduce adherence, and prevent people from asking clinicians about prevention. The impact is rarely distributed evenly. People from culturally and linguistically diverse communities, Aboriginal and Torres Strait Islander communities, transgender and gender-diverse communities, and regional areas may face additional barriers involving trust, confidentiality, transport, cost, or culturally safe care.

Peer education responds to the social nature of stigma. A trained peer can explain that PrEP is a routine prevention option, describe daily and event-based use where clinically appropriate, and share practical experiences without presenting one pathway as suitable for everyone.

Designing a credible community program

The strongest model begins with a co-design process. People who use PrEP, people considering it, sexual health clinicians, community advocates, pharmacists, and researchers should help shape the messages, delivery channels, and measures of success. Brisbane, Sydney, Melbourne, Perth, and regional Queensland may require different outreach strategies because community networks and service access vary.

Peer educators should receive training in HIV prevention, PrEP eligibility, adherence, side effects, testing, referral pathways, privacy, and communication across cultures. They should not replace medical advice. Their role is to create a trusted bridge to a nurse, doctor, pharmacist, or sexual health service.

Paid, supported positions are preferable to relying on unpaid emotional labour. Regular supervision can help educators manage difficult conversations and avoid sharing personal information beyond what feels safe. Digital sessions, community forums, clinic drop-ins, and private messaging can complement face-to-face education, particularly for people who do not want to attend a sexual health service publicly.

Turning evidence into everyday conversations

Messages should use plain language and focus on autonomy. A peer educator might explain that PrEP can be considered alongside condoms, regular HIV testing, treatment for other sexually transmissible infections, and communication between partners. The discussion should acknowledge that prevention choices can change over time.

Australian access information needs to be specific. PrEP has been subsidised through the Pharmaceutical Benefits Scheme for eligible people, although people without Medicare or with limited access to a regular prescriber may face different costs. Three-monthly HIV and sexual health checks are commonly part of ongoing PrEP care. Community pharmacies and telehealth services can improve convenience, particularly for people outside inner-city areas.

A local market perspective also matters. People may encounter PrEP information through dating applications, community events, pharmacies, university services, gyms, or LGBTQIA+ venues rather than traditional health campaigns. Materials should be available in formats that suit mobile use, while avoiding targeted advertising that could unintentionally disclose someone’s interests.

Protecting privacy, culture, and safety

Confidentiality must be visible in every part of the program. Registration forms should collect only necessary information, and peer educators should know how messages, attendance records, referrals, and evaluation data are stored. Participants need a clear explanation of who can access their information and when consent can be withdrawn.

Queensland and other Australian jurisdictions have privacy, anti-discrimination, public health, and professional practice requirements that affect program delivery. Governance should include an ethics review where research data are collected, as well as clear procedures for complaints, safeguarding, and incident response. Collaborative projects can also benefit from this intellectual property guide when developing educational resources with community groups and research partners.

Cultural safety should be built into recruitment and content review rather than added at the end. Aboriginal and Torres Strait Islander organisations, multicultural health services, and trans-led groups should have meaningful decision-making roles. Images and language should reflect real communities without suggesting that any identity or population is inherently associated with HIV.

Measuring whether stigma is changing

Evaluation should examine more than the number of brochures distributed or social media impressions. Useful baseline and follow-up measures can assess knowledge of PrEP, confidence discussing it, perceived stigma, willingness to seek testing, and understanding of where to obtain confidential care.

Qualitative interviews can reveal changes that surveys miss. Participants may describe feeling less judged at a clinic, correcting misinformation among friends, or becoming more comfortable discussing prevention with partners. Peer educators can record recurring questions and service barriers without identifying individuals.

Health services may track referral completion, new PrEP consultations, continuity of prescriptions, and attendance at recommended testing. These measures should be interpreted carefully. An increase in demand may show that outreach is working, while a fall in follow-up visits could indicate cost, transport, side effects, or an unsuitable service model.

Recommendations for implementation

A staged pilot can test the approach in Brisbane and one regional Queensland community before expansion. The following actions provide a practical foundation:

• Co-design the program with PrEP users, priority communities, clinicians, pharmacists, and researchers.
• Recruit peer educators who reflect the languages, cultures, genders, and experiences of the intended audience.
• Provide paid training, clinical supervision, referral protocols, and ongoing wellbeing support.
• Use confidential, mobile-friendly information alongside workshops at trusted community locations.
• Explain PBS access, prescribing options, testing requirements, costs, and privacy protections in plain English.
• Evaluate knowledge, stigma, referral completion, PrEP uptake, and participant experiences from the beginning.

A community-based peer education program can make HIV prevention feel ordinary, informed, and respectful. Its value lies in connecting reliable clinical evidence with the realities of relationships, work, transport, pharmacy access, culture, and privacy in Australian communities.

Health services, researchers, universities, community organisations, and people with lived experience can work together to pilot a locally governed model, assess its impact, and share findings through established health translation partnerships. Building that collaboration now can help more people access PrEP confidently and support Australia’s wider goal of reducing HIV transmission and improving sexual health equity.