Reaching the unreached: Co-produced PrEP engagement with vulnerable women in Norfolk

Norfolk County Council worked with Hitch Marketing to deliver a targeted campaign raising awareness of Pre-Exposure Prophylaxis (PrEP) among women at increased risk of HIV who are often under-served by mainstream health messaging. PrEP, when taken correctly, is highly effective at preventing HIV acquisition. The campaign used behavioural insight and co-production with women from priority groups and specialist partners to reduce stigma, improve understanding of PrEP and support trusted community organisations to initiate conversations about HIV prevention. Activity combined targeted digital advertising with discreet, community-led resources embedded within existing support services. 

Working with women from priority groups and VCSE partners, the team developed inclusive, plain-language, multilingual and discreet materials, combining targeted digital advertising with community-led delivery. Early evaluation showed strong engagement across settings, high resource distribution, and positive feedback on reduced stigma and improved understanding. Co-production created ownership and confidence among both women and frontline workers.

Women at heightened risk in Norfolk - including female sex workers, women engaging in transactional sex, women from ethnic minority communities (including refugees and asylum seekers), and women experiencing homelessness or unstable housing - were significantly underrepresented in both awareness of PrEP and actual uptake. Barriers included stigma, low perceived relevance of PrEP for women, limited trust in statutory services, language challenges, and a lack of culturally appropriate information. Norfolk County Council wanted an intervention to reduce stigma, normalise HIV prevention and enable frontline services to confidently start PrEP conversations. 

• Increase awareness of PrEP among women at heightened risk of HIV.
• Reduce stigma associated with HIV prevention and PrEP.
• Equip trusted community partners to initiate supportive conversations.
• Use behavioural insight and co-production to ensure cultural relevance.

Hitch developed a co-produced social marketing campaign grounded in the COM-B behavioural model, diagnosing capability, opportunity and motivation barriers to PrEP engagement. Women from priority groups and specialist voluntary, community and social enterprise (VCSE) partners helped shape key elements including inclusive imagery, plain-language, stigma-free messaging, multilingual and low-literacy materials, and discreet formats suitable for sensitive settings. Building trust and collaborative ownership with community organisations and frontline staff was central to the campaign’s design.

The campaign blended targeted digital activity with community-led offline delivery to maximise reach and relevance:

• Targeted digital advertising to raise awareness and normalise PrEP.
• Posters and discreet information cards distributed via trusted VCSE partners.
• Conversation guides to support staff and volunteers.
• Co-created materials embedded within existing support services.
• Multilingual resources to improve accessibility. 

Materials were deliberately flexible so partners could adapt them to their own settings, reinforcing local ownership and sustainability. 

Early evaluation using the RE-AIM framework showed strong adoption and engagement across community settings:

• 128,000+ impressions from digital activity.
• 1.77 per cent click-through rate on targeted ads.
• 1,400+ printed resources distributed through community partners.
• High uptake of discreet cards and posters in specialist settings.
• Positive qualitative feedback highlighting reduced stigma and improved understanding of PrEP. 

Women involved reported a strong sense of ownership and actively reinforced messaging through peer-led conversations. 

Community partners valued the co-production approach and the focus on cultural relevance. Frontline workers reported increased confidence initiating conversations about PrEP with women in their services.

• Co-production is essential for relevance and resonance with under-served groups.
• Combining digital and community delivery channels supports both awareness and trust.  
• Flexible materials help partners tailor delivery to specific audiences.

Nick Godbehere, Managing Director at Hitch Marketing Limited, [email protected]