Current situation

Current Situation in Sri Lanka 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 today’s 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.

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.

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 Common adolescent issues include; problems related to of opportunities to meet and play away from the watchful, prying reproductive and sexual health, accidents, and problems related Adolescents who engage in sexual activity outside of marriage eyes of parents or other adults because most villages (except for to mental health (United Nations Family Planning Association face social stigma, family conflict, problems with school and the those created through development projects) are comprised of 1997). Life styles and life skills are considered to be closely associated with many of these problems and have a tremendous potential need for unsafe abortion. Pregnancy, that occurs before dense and overlapping networks of relatives and children tend adolescents are fully developed, can also pose significant risks to have great license to roam. Adolescent children are watched impact on the wellbeing of adolescents. to infants, including birth injuries, lower birth weight and a lower over by parents or guardians, but they are frequently given work, chance of infant survival. such as taking the goats or cattle to grazing lands, guarding the paddy fields from birds and other predators, or fetching water

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.

Sexual Experience

Sources of Information on Reproductive Health and Related Issues

Love affairs among adolescents, a common primary source of sexual experience seemed to be quite common in Sri Lanka.

Urban areas are much different. Homes in middle to upper About 50% of adolescents have love affairs nearly half of those Sri Lankans disapprove discussing about Sex with class neighbourhoods are usually protected by a fence or wall, couples have informed their family about it suggesting the fact their adolescent children because it is perceived as a and children are usually watched by parents or servants. In urban that these relationships are meaningful long lasting relationships. generational taboo even though it is a natural development areas, love affairs are not uncommon in schools. These are process and a basic human need that should be fulfilled Basnayake (1996) reported that approximately 13% of irrespective of marital status. Sri Lankans never talk about usually intensely romantic relationships and involve passing notes to one another, secret meetings often arranged with the help of unmarried youth have experienced sexual intercourse. Sexual Sex openly without guilt or shame which conveys the idea friends and handholding or kissing. Such romances are accepted experience among adolescents aged 15–17, was found to be that we are sexually suppressed. and encouraged and are even sources of prestige among school 3.1%, where as in the 18–20 year age group it was 7.4%. peers, but they remain unacceptable to the parents of the lovers. Premarital sexual activity was found to be higher among urban Even though honest and open communication between The couple and their friends generally think of such romances unmarried youths (25%) than among rural youths (16%). A parents and children through childhood, pre-teen, as “young love” and do not expect them to lead to sexual significant gender difference was reported, 42.6% of urban adolescent and young adulthood can help young people to intercourse. For urban females from Westernized families, kissing males reporting sexual experience compared to 6.3% females, mature into sexually healthy adults, Sri Lankan parents and and handholding are daring but acceptable forms of premarital while rural male and female prevalence was 28.5% and 3.9 % guardians find it very uncomfortable to talk about or provide sex, but any form of receptive-penetrative sex, heavy petting respectively (the gap between the numbers is basically due to information about sex or sexual education. They are either or oral sex is considered morally and socially wrong. However, males being exposed to high risk sources such as commercial too embarrassed about talking about the extreme topic of the intensity of an idealized “young love” relationship can lead to sex workers). sex, afraid of providing too much information thinking it tragedy if the relationship does not eventuate in marriage. The will encourage a child to experiment with sex too early or Studies show that the first sexual encounter is often before they’re mature enough to deal with it or shy of not breakup of such adolescent love relationships has long been a experimental and most do not use contraceptives even if they knowing the answers to the questions that their children leading cause of suicide in Sri Lanka. know from where to get them as contraceptives are not freely may ask. On the other hand, most parents are not close to However, the current socio-demographic and economic available to adolescents and commercial sex workers are the their children and they are not aware of the changes that situation in Sri Lanka appears to promote premarital sexual main sexual contacts of youths. children are undergoing. Most parents view their children practices among adolescents and youth. Modernization, as just children until that time when one is pregnant or education, urbanization and busy competitive lives appears to infected with STIs. These things take most parents by have led to a culture where parental authority is diminished, family surprise because they are not aware that their children are ties are loosened and adolescents are secularized and left alone to active in sex. themselves. Uncontrolled and highly commercialized mass media appeals to them through music, dress and language promoting Many parents leave the role of educating their children a message of liberation, self-development and marginality from about sex to school, but there is no systematic sex education traditional ways, implicitly and explicitly promoting sexual freedom in Sri Lanka although efforts have been made to develop and sexual activity. since 1980s, thus students never get proper sex education from school. Advanced biology or general science courses

in high school do provide information on how sexual intercourse is performed, but this topic is very well ignored and skipped by the teacher asking the students to read it at home saying because it hardly gets 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 it’ll be embarrassing to face the students after teaching these lessons. On the other hand, most of the teachers who are allocated the role of providing sexual education are not qualified and as a result are not in a position to offer the much-needed knowledge.

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 Some students will not be comfortable when discussing passed on from one child to the other is mostly incorrect and this sexual matters with members of the opposite sex. This creates incorrect information is circulated between children which lead to an environment of uneasiness, which will not be good for the serious problems. 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 one’s 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.

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.

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 %.

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 can’t 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 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 don’t exceeded 50 %. About 50% - 60% of adolescents demonstrated positive attitudes towards HIV /AIDS patient s and attitudes improved with age.

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 can’t be considered satisfactory as the overall percentage of those with correct knowledge doesn’t 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.

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.

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).

It was reported that young men had no difficulty in discussing about their sexual experiences with other men and the opposite was true for young women as they would offer only little information. The same report indicated that sexual issues were more comfortably discussed among friends of the same sex than with those of opposite sex. About half of those who had a boyfriend or a girl friend said they had discussed sex with their partner.

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).

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 implemented will allow abortion for girls under 18 who have become pregnant due to rape or incest and for mothers carrying babies with severe genetic abnormalities. As said by Family Planning Association Sri Lanka about 1000 induced abortions are performed daily and 20% of these occur among young people.

deprived of psychiatric help. Staff at Sri Lanka’s lone centre for minors who become pregnant as a result of rape say residents are getting younger. Some victims are so young that they don’t 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 don’t 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 However, rape is particularly under reported as only few women to the penal code, stipulating that all offenses that violated the are willing to take the risks of humiliation and a prolonged difficult modesty of a woman were now punishable by a jail sentence. court case. If it becomes public knowledge that a woman was Such behaviours included any form of sexual harassment at raped, there is a high probability that her family will be disgraced. workplaces, during public transport, or at any other public place.

Chronic communal violence and inter ethnic hostilities have also led to higher incidences of rape across ethnic boundaries. In Child Sexual Abuse: January 2002, for the first time, Sinhalese soldiers were brought Child sexual abuse is one of the most difficult realities Sri to court for charges of raping a Tamil woman and were convicted.

Lankans face. As per Asian Tribune dated 16th January 2004, Female victims of sexual assault are most often admitted to every year 10,000 girls in Sri Lanka face sexual abuse by a Gynaecological ward and first seen by a Gynaecologist. The relatives in families where the mother has taken up overseas women are most often deprived of a prompt and appropriate employment, with most rapes committed by fathers. During the forensic examination because of the lack of facilities in most rural past five years, 512 cases of incest were reported, 54.5% of hospitals and the lack of knowledge of many of the attending them committed by fathers. According to Maureen Seneviratne, doctors. In addition, the clinician may be reluctant to be involved chairperson of the country’s premier child rights NGO, Protecting in a criminal investigation. Most of the rape victims are also 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.

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 Weeramunda’s (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.

Child Sexual Exploitation:

Sexually Transmitted Deseases (STDs):

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.

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 gap observed in reported prevalence, raises the possibility that a high proportion of young men may be initiating sexual activity with commercial sex workers and other unknown persons, thus increasing the risk of STIs and HIV / AIDS.

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 people’s behaviour would largely depend on the information, skills, and services that are available to them (UNAIDS/WHO).

Adult Prostitution/Sex Workers: The number of female sex workers in Sri Lanka varies from 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 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 Sex workers typically come from very poor families. According to Ratnapala’s (2005) random sample of 100 female sex workers living at brothels, 46 were married, 16 were deserted by their husbands and the remaining 38 were single. 28 were between 18 -25 years of age, 42 were between 26-30 years of age, and 30 were between 30-35 years of age. The majority of these sex workers did not voluntarily choose their profession, but were forced into it by dismal economic circumstances or were coerced into it sometimes by their husbands.

Happy Life Contact Centre was established in 2009 to enable people to get information on reproductive health related issues using information technology tools. It is the first facility of its kind in Sri Lanka to provide information on sexual and reproductive health matters. The Project is a joint initiative of FPA Sri Lanka and the Information Communication Technology Agency of Sri Lanka (ICTA) which provides technical support.

Information is provided by 4 medical doctors who are serving their internship period at the moment before they take up employment or go in for higher studies. Not only telephone calls, Google Trends emails, SMSs, but also chatting by MSN or Yahoo messenger, 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 scores 100 (out of 100) and Bangladesh and India are number caller is ensured and Sinhalese, Tamil and English are used for two and three with 87. Further it was shown that the researches communication. on these terms have been in peak in months of April and August “A substantial number of calls and queries directed to Happy which happen to be school vocation period. When scenes of Life are on emergency contraception. There are nearly forty calls kissing are cut in movies, couples are arrested in public parks every day, and half of these are by women and men seeking and hotel rooms by the Police, sex is considered as something information on emergency contraception. Queries may range exotic and shameful, incidents such as this is obvious occurrence. from issues of growing up, pregnancy, and sexual orientation, a variety of issues related to sexual and reproductive health.

A number of inquiries about relationships are made by young people. Questions on HIV and AIDS come up every now and then. There are queries from women and men who are currently using a method of contraception. There are times when the caller needs to be seen by a doctor when the complaint is of a medical nature. “We advise the caller to contact the nearest government health facility or the FPA clinic in Colombo which provides medical and counselling services,” said Dr. Imala.

The Family Planning Association of Sri Lanka (FPASL) The Family Planning Association of Sri Lanka (FPASL) complements Sri Lanka’s government health services with 5,300 services points: 6 permanent facilities, 6 mobile units and thousands of community based distributors and services (CBDs/ CBSs) and it focuses on reaching the most vulnerable groups in the society. A comprehensive range of sexual and reproductive health services including contraception, counselling, diagnostic services, HIV and STI screening and voluntary counselling and testing (VCT) is offered by clinics.

FPASL has developed a highly successful contraceptive retail sales programme, backed by major media campaigns, supplying around 60% of the condoms and 90% of the oral contraceptives sold in Sri Lanka. In 2011, 9.2 million condoms and 309,000 sexual and reproductive health services have been provided by FPASL. FPASL advocates increasing political commitment to reproductive health education with political and religious leaders, promotes female empowerment, seeks to eradicate unsafe abortion and liberalise abortion laws and aims to foster community involvement in projects. Additionally, it runs regular training sessions for staff, volunteers and personnel from outside organizations working in the SRH field.

Grassrooted Trust Grassrooted trust works in the fields of HIV, drugs and sexual and reproductive health and rights and focuses on improving the lives of young people, people who live with HIV or use drugs, people of diverse gender identities and sexual orientations and anyone marginalized or forbidden to engage with issues around sex, drugs and culture.

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.