Although comprehensive sexuality education programmes have the potential to improve the sexual health and well-being of young people, many socially conservative rural states in the USA have laws and policies restricting school-based comprehensive sexuality education and supporting abstinence-only education. This paper describes the process of building a community-university partnership to implement a community-based comprehensive sexuality education peer education programme for high-risk young people and presents preliminary findings from a longitudinal evaluation. Through purposive recruitment, the sample included 386 young people (mean age) who were more diverse than the local community. Important university-community partnership components included (1) establishing local connections and legitimacy, (2) adapting and tailoring programmes to meet community context, (3) sustainability planning, and (4) flexibility, persistence, and patience. Building community trust and capitalising on the mutual benefits of community-university partnerships are effective methods of building community sexuality education programming in a conservative environment. Tailoring evidence-based approaches to comprehensive sexuality education in a politically restrictive environment shows promise in improving the sexual and reproductive health of young people.