The sexual behaviour of US youth places them at risk of negative outcomes such as sexually transmitted infections and unintended pregnancy. The US Centres for Disease Control recommend a positive and respectful approach to sexuality and relationships to improve these outcomes. Yet, sexuality education across the country, especially in the US South, remains insufficient. Peer sexuality education programmes are a method to improve knowledge and influence risky sexual behaviours. However, support for such programmes is often limited in higher education. Partnerships across different types of higher education institutions may enhance feasibility through resource sharing. This study analysed data from focus group discussions with faculty/staff and students (6 groups, n = 18 faculty/staff, n = 21 students) at three different higher education institutions in North Carolina. Participants provided perspectives on institution-specific facilitators and barriers to discussing sexual health on campus. Perceived facilitators and barriers were similar between the predominantly white institution and the historically Black college/university, while the community college presented unique logistical issues that should be considered when developing peer sexuality education programmes.