We implemented population size estimation of female sex workers (FSW) and transgender women (TGW) in Sri Lanka in 2018 using several approaches (geographical mapping, service and unique object multiplier and a modified Delphi method during the stakeholder consensus meeting). Mapping was done in 49 randomly selected Divisional Secretariats, which provided a basis for extrapolation of size estimates to the national level. Two types of adjustments were applied on the mean (minimum-maximum) population estimate obtained during mapping: (1) an adjustment for mobility to reduce double counting of FSW and TGW frequenting multiple spots, obtained during mapping; (2) an adjustment for "a hidden population", obtained from surveys among FSW and TGW. For the multiplier method, we used data from services of non-governmental organisations that FSW and TGW were in contact with, and surveys based on respondent-driven sampling. Surveys were carried out in the cities of Colombo (FSW, TGW), Kandy (FSW), Galle (FSW) and Jaffna (TGW). We estimated that there are 30,000 FSWs in Sri Lanka, with a plausible range of 20,000-35,000, which implies a prevalence of FSW of 0.56% (0.37-0.65%) among adult females. This study provided baseline estimates of 2,200 TGW in the country, with a plausible range of 2,000-3,500, which is 0.04% (0.04-0.07%) of adult male population. Our estimates of the proportional contribution of the FSW and TGW populations among the adult population in Sri Lanka are consistent with the The Joint United Nations Programme on HIV/AIDS (UNAIDS) recommended estimates for Asia and the Pacific. The results provide an important point for macro-and micro-level planning of HIV services, allocating programme resources and assessing programme coverage and quality.

Introduction: Worldwide studies have identified varied correlates associated with test anxiety in school children. Such studies are rare in Sri Lanka.Objective: To explore the association between test anxiety and selected correlates in a group of 14-16 year old Sri Lankan school children.Method: All children (n=107) in the 10 th grade in a selected school completed a psychometric testbattery which was a part of a larger study. These included the Ravens Standard Progressive Matrices (assesses intelligence), Westside Test Anxiety Scale (assesses test anxiety), and the Personality Assessment Questionnaire (assesses personality maladjustment). The students also completed a socio-demographic questionnaire. Their previous semester academic averages were obtained from the school administration. The Colombo Medical Faculty Ethics Review Committee approved the study.Results: Personality maladjustment and test anxiety were significantly and positively correlated (Pearson coefficient correlation = 0.438). The students' previous semester academic scores were also analysed in relation to test anxiety using nonparametric methods. Academic averages showed a _________________________________________ Conclusions:The study indicates that increased personality maladjustment and female gender are associated with test anxiety. It also shows that increased test anxiety is associated with decreased academic performance.

Introduction:Youth is the period where individuals transform from dependent childhood to independent adults. The incidence of Sexually Transmitted Infections (STI) and HIV among youth in Sri Lanka, is rising.Objective: To assess the risk behaviours and vulnerabilities towards Sexually Transmitted Infections and HIV among youth attending youth corps centres in the Western province of Sri Lanka. Method:A descriptive cross sectional study was carried out using a self-administered questionnaire among the trainees attached to youth corps centres (YCC) in Western province from October 2019 to February 2020.Results: Youth attached to YCC were educated and were from poor economic background. A fair proportion had a good level of knowledge on STIs and HIV. Knowledge was positively associated with age, educational level and the wealth quintile. There is a significant difference of knowledge across ethnic and religious categories. Only 15.5% reported being sexually active and the majority of them (79.2%) were having multiple partners. Only 41% agreed that they would use condoms in the future. Sense of invulnerability, peer pressure, embarrassment to buy were the main reasons for not using a condom. Major source of SRH information was the internet and the available SRH services are underutilized, mainly due to unawareness.Conclusions: Knowledge on STIs and HIV among these youth was satisfactory and a minority were sexually active. Risk behaviours were higher and access to available SRH services were poor.

Background There are limited data globally on HIV in men who engage in casual and transactional sex with female tourists. Methods In 2018 we carried out a respondent-driven sampling (RDS) survey among beach boys in Galle, Sri Lanka, to determine prevalence of HIV and other infections, HIV risk behaviours and utilisation of HIV prevention services. Eligibility criteria included men who cruise in and around beach areas and who had anal and/or vaginal sex with female or male tourists in the 12 months before the survey. Results We recruited 373 beach boys. Approximately 49.6% of the participants were married, while 45.7% were single and 4.7% divorced, separated or widowed. A lower percentage of beach boys reported regular partners in the past 12 months (52.3%) compared to casual partners (95.4%). Condom use at last sex with a casual partner was higher (76.7%) compared to condom use with regular partners (58.3%). Condom use at last sex with a tourist was reported by 75.3%. Ever receiving money, goods or services in exchange for sex was reported by 39.7%. For 85.5% of beach boys who sold sex, the last paying partner was a tourist (85.5%) and a woman (82.0%). In the past 12 months before the survey, 32.3% of beach boys paid money for sex, and 99.5% did so from women. Ever been tested for HIV was reported by 35.3, and 69.1% of those were tested in the 6 months before the survey. In the adjusted multivariate analysis, significant correlates of never testing for HIV were lack of comprehensive knowledge about HIV and unprotected last sexual intercourse with tourists. The prevalent infections were: HIV, 0.3% (95% CI 0.0–0.4%); syphilis, 0.5% (0.0–1.2%); herpes virus type-2, 5.0% (2.5–7.5%). Conclusions There are low level HIV and syphilis prevalence among beach boys in Galle but a high level of sexual risk taking. Beach boys may be acting as a bridge for HIV transmission between higher-risk groups (paying female tourists, men who have sex with men) and lower-risk heterosexual female population in Sri Lanka. More research is needed in South-East Asia on men who trade sexual services to female and male tourists.

Background Biobehavioural data on transgender women (TGW) are limited globally. Methods: We used data collected as part of the 2017–18 National Integrated HIV Biobehavioural Survey, which included 254 TGW in Colombo and 252 in Jaffna, for structured questionnaire interviews and biological testing. We performed multivariable logistic regression analysis to explore factors associated with condom use. Results: We found low HIV prevalence in Colombo (0.6%) and no HIV infections in Jaffna. TGW in Colombo had higher positivity on the Treponema pallidum-particle agglutination test (2.5%) compared with TGW in Jaffna (0.4%). We found no hepatitis B infections. In both cities, <25% of TGW have comprehensive knowledge about HIV prevention. In Colombo 54.4%, but only 21.4% of TGW in Jaffna, have ever been tested for HIV. Drug-injecting behaviours are uncommon in both cities (prevalence <1%), whereas 7.4% reported sharing equipment for injecting feminising hormones in Colombo. Greater proportions of TGW in Colombo compared with Jaffna used condom at last sex (82.3% vs 37.7%). Multivariable analysis showed lower odds of condom use at last sex in TGW aged >30 years and those who did not test for HIV in the past 12 months in Colombo, and for TGW with higher income in Jaffna, TGW not visiting outdoor sites to find partners, and TGW who sold sex. Conclusions: Current burden of HIV, syphilis and hepatitis B among TGW in Sri Lanka is low. Although risk behavioural patterns vary between the cities, a substantial sexually transmitted infection vulnerability is a common denominator, calling for strengthening of the capacity to respond to specific TGW needs.