Proposed Adolescence Health and Youth Development Centre in Colombo, Sri Lanka

Perception of Sexuality of Sri Lankan Public

Sachintya Rajapakse

Background
Adolescents account for the 3.7 million (19.7%) of Sri Lankan population and more than 91.4 % adolescents complete primary education, 56.2 % receive an education beyond secondary level (Central Bank of Sri Lanka 1999). This contributes to a considerably longer period of dependence on parents and for many, dependence extends beyond adolescence in to youth. On the other hand todays adolescents have more opportunities to become better informed through a wide variety of communication systems available to them as well as through improved educational opportunities. This leads to high levels of aspirations, different attitudes and value systems. Yet, very few have adequate resources necessary to fulfil these aspirations and to materialize their attitudes and values. The majority has to be dependent on parents for their financial requirements, where some of the parents may not agree with adolescents views. In this context, the parent-adolescent relationship becomes an important factor that influences the physical and mental wellbeing of adolescents. Common adolescent issues include; problems related to reproductive and sexual health, accidents, and problems related to mental health (United Nations Family Planning Association 1997). Life styles and life skills are considered to be closely associated with many of these problems and have a tremendous impact on the wellbeing of adolescents.

Adolescents who engage in sexual activity outside of marriage face social stigma, family conflict, problems with school and the potential need for unsafe abortion. Pregnancy, that occurs before adolescents are fully developed, can also pose significant risks to infants, including birth injuries, lower birth weight and a lower chance of infant survival.

or goods from a store. It is acknowledged by adults that when adolescents are engaged in such tasks, they will flirt, display their genitals and engage in sex play. Urban areas are much different. Homes in middle to upper class neighbourhoods are usually protected by a fence or wall, and children are usually watched by parents or servants. In urban areas, love affairs are not uncommon in schools. These are usually intensely romantic relationships and involve passing notes to one another, secret meetings often arranged with the help of friends and handholding or kissing. Such romances are accepted and encouraged and are even sources of prestige among school peers, but they remain unacceptable to the parents of the lovers. The couple and their friends generally think of such romances as young love and do not expect them to lead to sexual intercourse. For urban females from Westernized families, kissing and handholding are daring but acceptable forms of premarital sex, but any form of receptive-penetrative sex, heavy petting or oral sex is considered morally and socially wrong. However, the intensity of an idealized young love relationship can lead to tragedy if the relationship does not eventuate in marriage. The breakup of such adolescent love relationships has long been a leading cause of suicide in Sri Lanka.

Sexual Behaviour
Rural Sinhalese homes are usually made with sun-baked brick, with tile or hay for the roofing and mostly comprises of an open area that extends into a garden where manioc, banana, coconut, and vegetables are grown. In rural areas, footpaths, cultivation fields, scrub lands, rivers, reservoirs, irrigation channels, forest lands and garden compounds are places where children meet, work and play. Rural children and adolescents have plenty of opportunities to meet and play away from the watchful, prying eyes of parents or other adults because most villages (except for those created through development projects) are comprised of dense and overlapping networks of relatives and children tend to have great license to roam. Adolescent children are watched over by parents or guardians, but they are frequently given work, such as taking the goats or cattle to grazing lands, guarding the paddy fields from birds and other predators, or fetching water

Sexuality
The median age at marriage among SriLankan women has been on the increase over the years (1963: 22.1yrs; 2002: 24.6 yrs) (DCS, 2002). As a result, a large number of young people at the peak of their sexuality spend a long period of time out of marriage. Some of them tend to engage in premarital sexual activities exposing themselves to the health and social risks of pregnancy and STDs.

However, the current socio-demographic and economic situation in Sri Lanka appears to promote premarital sexual practices among adolescents and youth. Modernization, education, urbanization and busy competitive lives appears to have led to a culture where parental authority is diminished, family ties are loosened and adolescents are secularized and left alone to themselves. Uncontrolled and highly commercialized mass media appeals to them through music, dress and language promoting a message of liberation, self-development and marginality from traditional ways, implicitly and explicitly promoting sexual freedom.

Sources of Information on Reproductive Health and Related Issues

Sexual Experience
Love affairs among adolescents, a common primary source of sexual experience seemed to be quite common in Sri Lanka. About 50% of adolescents have love affairs nearly half of those couples have informed their family about it suggesting the fact that these relationships are meaningful long lasting relationships.

any questions set on it in the exam because he is either afraid of the loaded questions the curious 15 year olds in the class or thinks that itll be embarrassing to face the students after teaching these lessons. On the other hand, most of the teachers who are Sri Lankans disapprove discussing about Sex with their allocated the role of providing sexual education are not qualified adolescent children because it is perceived as a generational and as a result are not in a position to offer the much-needed taboo even though it is a natural development process and a knowledge. basic human need that should be fulfilled irrespective of marital Some students will not be comfortable when discussing status. Sri Lankans never talk about Sex openly without guilt or sexual matters with members of the opposite sex. This creates shame which conveys the idea that we are sexually suppressed. an environment of uneasiness, which will not be good for the Even though honest and open communication between parents and children through childhood, pre-teen, adolescent and young adulthood can help young people to mature into sexually healthy adults, Sri Lankan parents and guardians find it very uncomfortable to talk about or provide information about sex or sexual education. They are either too embarrassed about talking about the extreme topic of sex, afraid of providing too much information thinking it will encourage a child to experiment with sex too early or before theyre mature enough to deal with it or shy of not knowing the answers to the questions that their children may ask. On the other hand, most parents are not close to their children and they are not aware of the changes that children are undergoing. Most parents view their children as just children until that time when one is pregnant or infected with STIs. These things take most parents by surprise because they are not aware that their children are active in sex. students as they are reluctant to ask questions or to participate actively in lessons. In addition, the discussions may bring out excitement in the students that may result in giggling during the lesson. Sometimes sexual education may not be in accordance with ones cultural and religion as some religions do not allow the discussion of sexual matters between people who are not married, therefore this places some students in difficult positions because they do not know what to say during sex education classes. Additionally some cultural beliefs take sexual discussions as a taboo. Thus, there is an inadequacy of sources of correct information on sexuality and family life and adolescents frequently turn to equally misinformed friends for information. In adolescents from schools in Western Province, friends are found to be the chief source of information on sexual matters. 61.5% of male students and 51% of female students obtained such information from friends. Friends of the same sex were most likely to be cited as the most suitable source for consultation and help with problems related love (79%). Parents and siblings are the source in 41% of females but only 13% of males obtained information from this source (AIDS- Coalition 2000). This is harmful as the information passed on from one child to the other is mostly incorrect and this incorrect information is circulated between children which lead to serious problems.

Basnayake (1996) reported that approximately 13% of unmarried youth have experienced sexual intercourse. Sexual experience among adolescents aged 1517 was found to be 3.1%, where as in the 1820 year age group it was 7.4%. Premarital sexual activity was found to be higher among urban unmarried youths (25%) than among rural youths (16%). A significant gender difference was reported, 42.6% of urban males reporting sexual experience compared to 6.3% females, while rural male and female prevalence was 28.5% and 3.9 % respectively (the gap between the numbers is basically due to Many parents leave the role of educating their children about males being exposed to high risk sources such as commercial sex to school, but there is no systematic sex education in Sri sex workers). Lanka although efforts have been made to develop since 1980s, Studies show that the first sexual encounter is often thus students never get proper sex education from school. experimental and most do not use contraceptives even if they Advanced biology or general science courses in high school do know from where to get them as contraceptives are not freely provide information on how sexual intercourse is performed, but available to adolescents and commercial sex workers are the this topic is very well ignored and skipped by the teacher asking the students to read it at home saying because it hardly gets main sexual contacts of youths.

Knowledge on Reproductive Health and Related Issues

The following information were obtained by the National Survey on Emerging Issues among Adolescents undertaken by Neil Thalagala (M.B.B.S., M.Sc. Community Medicine, M.D. Community Medicine), Lalini Rajapakse (M.B.B.S., Dip. Child Health, Dip. Population Studies, M.Sc. Epidemiology, M.D. Community Medicine),UNICEF Coordinator: Harischandra Yakandawala (MBBS, MSc) and Medistat Research (Pvt) Limited in 2004.

The knowledge on different aspects of menstruation is limited to approximately 40 % of the sample. As expected the knowledge among girls is better than boys, the proportions however exceed 50 %. The prevalence of the common misconception about menstruation is high. Knowledge of adolescents on the possibilities / risk of conception and signs of pregnancy is very poor and percentage of adolescents who can correctly answer the questions on these is less than 25 %. The knowledge on risks entailed in induced abortions, frequent child bearing is limited to a proportion of adolescents less than 45%. Contraceptive methods are known to only a small proportion of adolescents. Condoms are the most frequently known contraceptive method (29%) followed by pills (24%). Other methods, DepoProvera, IUD, Norplant, Vasectomy, LRT and ECP are known by less than 10 % of adolescents. Knowledge increases with age and socio-economic status but yet the proportions of those who cant answer even in the older age groups and higher socio-economic levels are considerably high.

Knowledge on Reproductive Health among Out of School Adolescents:

The knowledge of out of school adolescents on menstruation, reproductive physiology conception pregnancy and contraception is better than the levels of knowledge among in school adolescents overall knowledge cannot be considered satisfactory. As expected they are more aware of contraceptive methods, oral contraceptive pills are known to 70% while emergency contraceptives and condoms are known to 42% and 68% respectively. However, only a very small proportion of out of school adolescents (less than 4 %) say that they have ever used any form of contraceptives, emergency contraceptive pills being the most commonly used method (3.7%). In general, knowledge on reproductive health among adolescents can be considered as very poor despite the fact that some of the areas of knowledge inquired are included in the school curriculum. It is important to note that most adolescents in Sri Lanka leave school after secondary education and thereafter have little opportunity to obtain knowledge on reproductive matters.

Knowledge on Reproductive Health among School-Going Adolescents:

More than 70% of the 10 13 years olds are not aware of the physiological changes that take place in their own bodies during adolescence. Knowledge of 14-19 year olds on matters related to reproduction such as production of sperms, ova, conception, sex hormones, secondary sexual characteristics, nocturnal emissions, fertility is very limited. The percentages of adolescents who can correctly answer the questions on the above aspects are less than 50 %.

Knowledge and Attitude on STDs among in School Adolescents:

Knowledge on STD/HIV /AIDS among adolescents s is found very poor. Only 57 % of adolescents are aware of the existence of sexually transmitted diseases in general. 59% are aware of HIV /AIDS while Gonorrhoea, Syphilis, Herpes, Genital warts are known to less than 40 %. Symptoms and signs of STDs and the knowledge on prevention of STDs are poor and only less than 20% of adolescents know the correct answers for questions on the above aspects. The knowledge on transmission and prevention of HIV /AIDS is relatively better compared to knowledge on other STDs. However, proportions of adolescent who have correctly answered to the questions on HIV/AIDS dont exceeded 50 %. About 50% - 60% of adolescents demonstrated positive attitudes towards HIV /AIDS patient s and attitudes improved with age.

District Variations:
On average Colombo, Jaffna, Batticaloa, Kalutara and Kandy districts recorded relatively higher proportions of adolescents(10 -13 years) with knowledge on physiological changes during adolescence. On average the knowledge of the adolescents from the districts in the North and East region and Nuwara Eliya district was lower than that of the adolescents in other areas. The knowledge on menstruation also showed a similar pattern. The knowledge on conception, pregnancy and child bearing was found to be lowest among adolescents in the districts of Northern and Eastern provinces and among those from Nuwara Eliya district. Colombo (49%), Kalutara (47%), Puttalam (43%) and Kurunegala (42%) districts reported the highest proportions of adolescents who had heard of contraceptive methods.

Knowledge and Attitude on STDs among Out of School Adolescents:

The knowledge of out of school adolescents on HIV/AIDS and symptoms and signs of STDs is marginally higher among out of school adolescents compared to those in schools reflecting a knowledge transfer through community channels. However, overall knowledge cant be considered satisfactory as the overall percentage of those with correct knowledge doesnt exceed 50%. It is estimated that Sri Lanka is still in the beginning of the HIV epidemic and successful control will depend on knowledge, attitudes and practices of adolescents and youth to a large extent. Therefore, it is important to plan strategies specific to adolescents to impart knowledge and improve skills necessary for the prevention of an HIV epidemic.

Attitudes towards Sex

A study of adolescents conducted in the Western Province of Sri Lanka reported that one third of them were visibly uncomfortable in dealing with sexual issues with the interviewers. 85% of male students and 66.5% of the females felt comfortable talking to friends on sexual health issues but only 27% of females and 8% of males were comfortable talking to their parents. They appeared unlikely to be open to their siblings either, only 7% of females and 3% of males reported being comfortable in discussing sexual matters with siblings. Very few (4% percent of females and 7% of males) were comfortable in discussing sexual issues with their teachers (AIDS Coalition 2000).

Issues and Behaviours

Coercive

Sexual

Adolescent Pregnancy and Rape:

Adolescence pregnancy occurs mainly due to careless sex between partners and rape cases and this is a major concern because of its impact on the overall health and well-being of both mother and child. In particular, pregnant adolescents are more likely to suffer Eclampsia and obstructed labor compared with women who are pregnant in their early twenties.

Under the Penal Code of 1883 abortion is illegal in Sri Lanka. According to Minister Tissa Karalliyadda, the change of law once It was reported that young men had no difficulty in discussing implemented will allow abortion for girls under 18 who have about their sexual experiences with other men and the opposite become pregnant due to rape or incest and for mothers carrying was true for young women as they would offer only little babies with severe genetic abnormalities. As said by Family information. The same report indicated that sexual issues were Planning Association Sri Lanka about 1000 induced abortions more comfortably discussed among friends of the same sex are performed daily and 20% of these occur among young than with those of opposite sex. About half of those who had a people. boyfriend or a girl friend said they had discussed sex with their However, rape is particularly under reported as only few women partner. are willing to take the risks of humiliation and a prolonged difficult About half (52.5%) of Sri Lankan youth were reported to approve pre marital sexual relationships (UNFPA 1996). A marginally higher proportion (Males 50 %, Females 25 %), approved pre marital sex among couples engaged to be married. A smaller proportion (Males 15 % females 6 %) approved pre marital sex among couples who were in love but with no plans to get married (Basnayake 1989). Sri Lankan adolescents were reported to generally prefer behaviours perceived to protect female virginity, such as inter-femoral and other forms of nonpenetrative sex (WHO 2003). court case. If it becomes public knowledge that a woman was raped, there is a high probability that her family will be disgraced. Chronic communal violence and inter ethnic hostilities have also led to higher incidences of rape across ethnic boundaries. In January 2002, for the first time, Sinhalese soldiers were brought to court for charges of raping a Tamil woman and were convicted. Female victims of sexual assault are most often admitted to a Gynaecological ward and first seen by a Gynaecologist. The women are most often deprived of a prompt and appropriate forensic examination because of the lack of facilities in most rural hospitals and the lack of knowledge of many of the attending doctors. In addition, the clinician may be reluctant to be involved in a criminal investigation. Most of the rape victims are also

deprived of psychiatric help. Staff at Sri Lankas lone centre for minors who become pregnant as a result of rape say residents are getting younger. Some victims are so young that they dont even understand how they became pregnant. Cases of sexual abuse of female minors increased 46 percent from 2006 to 2011. Exposure to pornography thanks to increased Internet and mobile phone access is cited as one possible factor. Meanwhile advocates are pushing for an increase punishment for child rape that may include the death penalty. Most of the raped victims dont want to keep their babies because of the social stigma attached to raising a baby as a result of rape, and especially at young age, so they plan to put their children up for adoption.

Sexual Harassment:
Until 1995, sexual harassment was not considered a crime except if it included physical violence. Public sexual harassment, such as a male pressing up against a woman and simulating intercourse on a bus, pinching, or making lascivious remarks, are all referred to as Eve teasing. These behaviours had become so prevalent that in 1995, the government added section 345 to the penal code, stipulating that all offenses that violated the modesty of a woman were now punishable by a jail sentence. Such behaviours included any form of sexual harassment at workplaces, during public transport, or at any other public place.

Child Sexual Abuse:

Child sexual abuse is one of the most difficult realities Sri Lankans face. As per Asian Tribune dated 16th January 2004, every year 10,000 girls in Sri Lanka face sexual abuse by relatives in families where the mother has taken up overseas employment, with most rapes committed by fathers. During the past five years, 512 cases of incest were reported, 54.5% of them committed by fathers. According to Maureen Seneviratne, chairperson of the countrys premier child rights NGO, Protecting Environment and Children Everywhere (PEACE), the worst

sufferers were girls in the age group of 10-14. Most of these women are from the lowest strata of society and are married to men who are casual workers in the plantation sector, construction and so on. Seneviratne further says that the problem areas are the western coastal belt and the poverty-stricken Uva province, from where around 900,000 women have gone abroad. Around 85% of them are married. Says psychology lecturer at Colombo University, Tilak Hettiarachchi: In most cases, what happens is that once the wife starts sending money from abroad, the husband gives up his job and hits the bottle. With the man spending most of his time at home, the girl child becomes the victim of this changed lifestyle. PEACE has initiated a project to help such children in Badulla district in Uva province. Their target group is girl children of migrant mothers in the plantation sector where alcoholism is rampant among labourers. In 1995, the government included incest - which was earlier treated as an offence under the marriage laws - under the penal code. However, police still classify all incest cases under the rape category. Unfortunately, not disclosing sexual abuse adds to the trauma for the child and has repercussions which may last a lifetime. The child will most certainly feel guilt, shame, self-blame, and may carry the dark secret for years. Sexually abused children struggle with anxiety, fear, and issues of trust, safety, and selfesteem fear of both the family and outsiders. For teenagers, there may be increased aggression; hostility and some may turn to drugs and other high-risk behaviours for consolation later in life.

Child Sexual Exploitation:

Sexual exploitation in Sri Lanka has been closely linked with the sex-tourist industry. In 2001, an organization called Protecting Environment and Children Everywhere (PEACE) was established with the goal of protecting Sri Lankan children from sexual exploitation. PEACE is affiliated with the End Child Prostitution in Asian Tourism campaign and supported through the United Nations.

Boy prostitution has been available in cities by organized groups for locals, but organized prostitution of boys for foreign clients is a recent phenomena. According to Weeramundas (1996) survey conducted with school children in 3 schools in Kalutara District situated near tourist hotels, 87 of the children (3%) said they had had sexual relationships with tourists, nearly two thirds of children being sexually exploited were male, 12% had their first sexual encounter at 10 years and the majority were between 12 and 14 years old. According to Miles (2000) selfadministered questionnaire survey with school children aged 13 to 17 years in 4 schools in Moratuwa, 10% of children said they had done sexual things: 8% with other children their age, 5% with adults and 6% with adults for money. He further reports that most children felt it was not acceptable for children to do sexual things with adults and appeared to be strongly against the damage they felt it could do to children and their communities. An estimated 1.2 million Sri Lankans work in the Middle East and 79% of unskilled migrants are women leaving children more vulnerable to abuse from relatives and neighbours. 100,000 child domestics are at high risk of physical/sexual abuse from their employers, though further research is needed to confirm this. Boys at boarding school and other children in residential care, especially children with disabilities, are more likely to be vulnerable to sexual abuse from house parents.

UNAIDS (Joint United Nations Programme on HIV/AIDS) estimates that about 3,000 Sri Lankans are affected with HIV at the end of 2009. The main mode of transmission is unprotected sex between men and women 82.8%, men who have sex with men account for 11.2% of the transmission, while mother to child transmission was 5.4% and transmission through blood and blood products was 0.4%. As of March 2010, 1223 HIV positive persons were reported in the country out of which 208 died. 353 cases were reported in 2009. The proportion of women infected with HIV has been rising, from 21% (19871991) to 42% (2007), in part because of increased testing of women over the last few years. The estimated number of children needing treatment in 2009 was 25%. Every year estimates of detected STI cases in Sri Lanka vary from about 60,000 to 200,000, of which only 10-15% are reported by government clinics. The highest rates of infection for STIs including HIV are found among young people age 20 to 24; the next highest rate occurs among adolescents age 15 to 19. The available data shows that about 77 % of HIV positives are within the 20 - 44 age groups. Given the time for the incubation period, some of them would have initiated the illness during their adolescence (Ministry of Health). The current trends suggest that Sri Lanka is still in the beginning of the left half of epidemic curve and the future of the HIV epidemic lies in the hands and behaviour of young people. Young peoples behaviour would largely depend on the information, skills, and services that are available to them (UNAIDS/WHO).

Sexually Transmitted Deseases (STDs):

STIs pose a significant risk for adolescents. The lower prevalence of pre marital sexual activity among young women in Eastern cultures like Sri Lanka and the considerable gender Adult Prostitution/Sex Workers: gap observed in reported prevalence, raises the possibility that The number of female sex workers in Sri Lanka varies from a high proportion of young men may be initiating sexual activity with commercial sex workers and other unknown persons, thus 35,000 to 47,000 and the vast majority are in the Colombo area. Most of their clients are Sri Lankans, but tourists are the target increasing the risk of STIs and HIV / AIDS. clienteles that have urged the rapid and extraordinary growth of

the sex industry. 10% of these sex workers are rural adult sex Government and Non Government workers and these sex workers mostly live in rural market towns, Organizations who Provide Information either in a hotel or rented house where they receive their clients and Sex Education and these clients are generally other villagers, town merchants, traders who are coming for the weekly market and soldiers. Happy Life Contact Centre

The Family Planning Association of Sri Lanka (FPASL)

The Family Planning Association of Sri Lanka (FPASL) complements Sri Lankas government health services with 5,300 services points: 6 permanent facilities, 6 mobile units and Happy Life Contact Centre was established in 2009 to enable thousands of community based distributors and services (CBDs/ Sex workers typically come from very poor families. According to Ratnapalas (2005) random sample of 100 female sex people to get information on reproductive health related issues CBSs) and it focuses on reaching the most vulnerable groups in workers living at brothels, 46 were married, 16 were deserted using information technology tools. It is the first facility of its kind the society. A comprehensive range of sexual and reproductive by their husbands and the remaining 38 were single. 28 were in Sri Lanka to provide information on sexual and reproductive health services including contraception, counselling, diagnostic between 18 -25 years of age, 42 were between 26-30 years of health matters. The Project is a joint initiative of FPA Sri Lanka services, HIV and STI screening and voluntary counselling and age, and 30 were between 30-35 years of age. The majority of and the Information Communication Technology Agency of Sri testing (VCT) is offered by clinics. these sex workers did not voluntarily choose their profession, but Lanka (ICTA) which provides technical support. FPASL has developed a highly successful contraceptive retail were forced into it by dismal economic circumstances or were Information is provided by 4 medical doctors who are serving sales programme, backed by major media campaigns, supplying coerced into it sometimes by their husbands. their internship period at the moment before they take up around 60% of the condoms and 90% of the oral contraceptives employment or go in for higher studies. Not only telephone calls, sold in Sri Lanka. In 2011, 9.2 million condoms and 309,000 Google Trends emails, SMSs, but also chatting by MSN or Yahoo messenger, sexual and reproductive health services have been provided by FPASL. According to Google, Sri Lanka is number one in regional Google Talk, Skype or the chat option in Happy Life website can interest for search terms relating to Sex. By a mile, Sri Lanka be used 24/7 to reach the Counsellors. The anonymity of the FPASL advocates increasing political commitment to scores 100 (out of 100) and Bangladesh and India are number caller is ensured and Sinhalese, Tamil and English are used for reproductive health education with political and religious two and three with 87. Further it was shown that the researches communication. leaders, promotes female empowerment, seeks to eradicate on these terms have been in peak in months of April and August A substantial number of calls and queries directed to Happy unsafe abortion and liberalise abortion laws and aims to foster which happen to be school vocation period. When scenes of Life are on emergency contraception. There are nearly forty calls community involvement in projects. Additionally, it runs regular kissing are cut in movies, couples are arrested in public parks every day, and half of these are by women and men seeking training sessions for staff, volunteers and personnel from outside and hotel rooms by the Police, sex is considered as something information on emergency contraception. Queries may range organizations working in the SRH field. exotic and shameful, incidents such as this is obvious occurrence. from issues of growing up, pregnancy, and sexual orientation, Grassrooted Trust a variety of issues related to sexual and reproductive health. Grassrooted trust works in the fields of HIV, drugs and sexual A number of inquiries about relationships are made by young people. Questions on HIV and AIDS come up every now and and reproductive health and rights and focuses on improving the then. There are queries from women and men who are currently lives of young people, people who live with HIV or use drugs, using a method of contraception. There are times when the caller people of diverse gender identities and sexual orientations and needs to be seen by a doctor when the complaint is of a medical anyone marginalized or forbidden to engage with issues around nature. We advise the caller to contact the nearest government sex, drugs and culture. health facility or the FPA clinic in Colombo which provides medical and counselling services, said Dr. Imala.

Work Plan for 2013: -HIV prevention programmes in partnership with the National Union of Seafarers in Sri Lanka. -Theatre productions on violence & HIV performed in Sinhala, Tamil and English based on Sri Lankan stories. -Comprehensive age appropriate sexuality education for students from Grade 1 in St Thomas College Mount Lavinia including working with parents and teachers to ensure that all stakeholders are on the same page. -Economic sustainability for improving skills and business opportunities for women and girls those who live with HIV, who involve in Sex work and who have survived violence. -Comprehensive sexual health survey for young people aged between 18 and 24 in 12 administrative districts of Sri Lanka.