BY Ruwan Laknath Jayakody
Even though the human immunodeficiency virus (HIV) epidemic among beach boys in Galle is still at a low level, there are multiple and overlapping risks for HIV transmission due to increasing travel to Sri Lanka from countries and population groups with a higher prevalence of HIV, and other sexually transmitted infections (STIs), and exposure to contexts that may amplify risks, including HIV-related risky behaviours associated with female tourists, thus creating a priority for HIV-related interventions.
These observations were made in a research article on “Beach boys in Galle: Multiple HIV risk behaviours and potential for HIV bridging” which was authored by I. Bozicevic (attached to the World Health Organisation’s [WHO] Collaborating Centre for HIV Strategic Information, University of Zagreb School of Medicine, Croatia), and A. Manathunge, S. Beneragama and C. Gadjaweera (all three attached to the National Sexually Transmitted Disease [STD]/Acquired Immunodeficiency Syndrome [AIDS] Control Programme, Ministry of Health) and published in the BMC Public Health journal in October, 2020.
The “Country HIV factsheets” of the Joint United Nations Programme on HIV/AIDS estimated that 3,500 (3,000-4,100) persons aged 15 years and above were living with HIV in Sri Lanka at the end of 2018, and that the HIV prevalence among those between the ages of 15 to 49 years was over 0.1%. In 2018, 350 cases of HIV were reported, per the Ministry's National STD/AIDS Control Programme's “Annual report 2018”. In the period between 2011 and 2018, the number of reported cases increased from 78 to 285 in men, respectively, while around 60 cases were annually reported in women.
The Ministry's National HIV Strategic Plan for Sri Lanka for 2018-2022 identifies female sex workers, men who have sex with men, transgender persons, beach boys (defined as men who work or socialise on tourist beaches or close to beaches, and who offer sex to men and women in exchange for money or some form of gratification, and many of whom work in the tourism industry, in restaurants, hotels, guest houses, and boat related tourism), people who use drugs and people who inject drugs as key populations for HIV transmission.
Bozicevic et al. conducted a round of the integrated bio-behavioural survey (IBBS) from March to June 2018, using respondent driven sampling among beach boys in Galle in order to determine the prevalence of HIV, syphilis and herpes simplex virus type-two (HSV-2), corresponding risk behaviours and the utilisation of HIV prevention services.
Galle is a coastal City in the South-West with a rapidly growing tourism industry. During 2018, per the Tourism Development Authority's “Annual statistical report 2018”, out of the total 12,608,044 foreign-tourist nights in graded accommodation establishments, 4,521,094 (35.9%) were in the Southern coast resort region.
M.A. Bellis, K. Hughes, R. Thomson and A. Bennett's “Sexual behaviour of young people in international tourist resorts” and S. Hawkes and G. Hart's “The sexual health of travellers” mentions that international tourists are more likely to engage in risk related sexual behaviours when outside their own community. R. Vivancos, I. Abubakar and P.R. Hunter's “Foreign travel, casual sex, and STIs: Systematic review and meta-analysis” showed that casual sex while travelling is relatively common, although this varies by the country of residence, destination, and nature of travel. A British study noted that 9.2% of men and 5.3% of women reported new sexual partners while being abroad in the preceding five years.
The criteria for inclusion in the survey 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.
The questionnaire was completed in a face to face interview and included questions regarding their social network sizes (assessed as the number of beach boys that the participants know by name, are older than 18 years, live in Galle, and whom they have seen in the past month), and HIV testing history (the receipt of at least two out of the following HIV prevention services from a non-Governmental organisation or a health care provider in the past three months, namely, condoms and lubricants, counselling on condom use and safe sex, and testing for STIs), among others.
Key indicators that were considered were knowing the HIV status from a HIV test, condom use at the time they last had sex with a casual partner, coverage with HIV prevention programmes, discriminatory attitudes towards people living with HIV and age.
A total of 373 beach-boy respondents were recruited in Galle from February to May, 2018.
The median (the middle number or centre value in a data set) network size (the number of beach boys older than 18 years who live in Galle that the participants knew and met in the past one month) was 13 (range: two-50).
The median age of the beach boys in Galle was 30 years (range: 18-72 years). A total of 61.8% of the respondents had regular work while 31.5% had occasional work and 6.2% were unemployed. Almost a half of the participants were married (49.6%), while 45.7% were single, and 4.7% divorced, separated or widowed. All respondents were born in Sri Lanka and Galle was the District of residence in the year before the survey for the vast majority. Never attending school was reported by 2.4%, while 49.6% had completed primary school, and 48% of the participants had completed secondary school education.
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%). In the seven days before the survey, beach boys reported a median of two sexual partners (range: zero-20), while in the 12 months preceding the survey, they had a median of six partners (range: 1-50).
Ever having anal sex with another man was reported by 16% and ever injecting drugs by 2.9%.
For one in four beach boys, the last sexual intercourse with a tourist was unprotected, and the commonest explanations given for this were the non-availability of condoms (51.9%) and thinking that condom use was not necessary (42.1%).
In terms of sexual relationships with tourists, among married beach boys (152), 83.7% have only female tourists as partners, 6% only male tourists and 10.2% both male and female tourists. Among the never-married and single (156), 75.7% reported having only female tourists as partners, 7.9% only male, and 16.4% both male and female tourists. Those who were divorced, widowed, or separated reported only female tourists as partners.
About one-third (39.7%) ever received money, goods or services in exchange for sex, and the majority (94.7%) did so in the 12 months before the survey. For a majority of the beach boys that sold sex, the last paying partner was a tourist (85.5%) and a woman (82%). Tourists that beach boys had sex with in the 12 months before the survey were most frequently from Germany, Russia, France, and Thailand. The amount of money typically received in exchange for sex was $ 21.
In the past 12 months before the survey, 32.3% of the beach boys were paid money for sex, and the majority (99.5%) did so from women.
Compared to the first IBBS carried out in 2015, certain HIV related behavioural and prevention indicators significantly improved in 2018, such as condom use at the time of last sex for which money was received, and testing for HIV. In contrast to these improvements, the proportion of beach boys who reported not knowing the HIV status of the last casual partner increased in 2018 when compared to 2015.
Approximately one in three respondents (38.4%) correctly identified both the ways of preventing the sexual transmission of HIV, and rejected major misconceptions about HIV transmission.
Somewhat more than a half of the participants (58.3%) do not consider themselves to be at risk of HIV, while 31.4% said that they could not estimate whether or not they were at risk. Only 7.3% estimated their risk to be moderate or high.
Ever being tested for HIV was reported by 35.3, and 69.1% of those were tested in the six months before the survey. Of those tested, 94.5% indicated a negative test result while the others reported not getting a test result. The majority of the respondents (94%) were last tested for HIV at a governmental STI clinic. Between 2015 and 2018, the uptake of HIV testing among beach boys increased substantially.
The commonest reasons given for not testing for HIV were the lack of time (45%), and not being at risk of HIV (32.9%), followed by an inconvenient testing location (16%).
Overall, coverage with HIV prevention among beach boys was 14.7%.
Significantly lower odds of never testing for HIV were found among beach boys who demonstrated the most comprehensive knowledge about HIV compared to those with at least one incorrect answer on the knowledge related questions, and higher odds among those who did not use a condom at the time of last sexual intercourse with tourists for which they were paid compared to those who did use. Marginally lower odds of never testing for HIV were found among those with more than two partners in the past 12 months.
One person was found to be positive for HIV, giving a HIV prevalence of 0.3%. Particular antibodies were detected in 0.5% (0.0–1.2%) while only one person had a weakly reactive particular test result suggestive of an active syphilis infection while HSV-2 antibodies were found in 5% (2.5–7.5%).
This study demonstrates the still low level of HIV and syphilis prevalence among beach boys in Galle but a high level of sexual risk taking in a variety of contexts and relationships. HSV-2 prevalence was also relatively low.
E.E. Freeman, H.A. Weiss, J.R. Glynn, P.L. Cross, J.A. Whitworth, and R.J. Hayes's “HSV-2 infection increases HIV acquisition in men and women: Systematic review and meta-analysis of longitudinal studies” and a Middle Eastern and North African study pointed out that HSV-2 serology is a powerful marker of sexually risky behaviour and that therefore, it should be a standard component of HIV surveillance surveys in such a low-level HIV epidemic setting.
Another finding was that beach boys may be acting as a bridge for HIV transmission between higher-risk groups (paying female tourists, and men who have sex with men) and the lower-risk heterosexual female population in Sri Lanka. This is supported by the finding that up to 16% of the married beach boys have sex with both male and female tourists. A.L. Bowring, V. Veronese, J.L. Doyle, M. Stoove, and M. Hellard's “HIV and sexual risk among men who have sex with men and women in Asia: A systematic review and meta-analysis” elaborates that some of these beach boys might be behaviourally bisexual due to the stigmatisation of homosexuality, and social norms and expectations to marry, as found in many Asian countries, while a Vietnamese study, F. van Griensven and J.W. de Lind van Wijngaarden's “A review of the epidemiology of HIV infection and prevention responses among men who have sex with men in Asia” and the WHO’s “HIV/AIDS among men who have sex with men and transgender populations in South-East Asia: The current situation and national responses” emphasise that some may be primarily attracted to women but have situational sex with men due to financial gain or experimentation.
A third of the beach boys reported selling sex to female tourists in a year before the survey while one in four did not use a condom at the last time of transactional sex with tourists. Sexual relationships between local men and tourist women are typically relationships between individuals who are unequal in terms of economic power. A Caribbean study observes that the complexity of these power relations and different expectations that partners in these relationships may have, may lead to lower condom use. K. Ragsdale, W. Difranceisco, and S.D. Pinkerton's “Where the boys are: Sexual expectations and behaviour among young women on holiday” and J.S. Taylor's “Female sex tourism: A contradiction in terms?” suggests that some women holidaying in developing countries may have expectations of longer-term romantic relationships while some travel explicitly for sex. E. Herold, R. Garcia, and T. Demora's “Female tourists and beach boys: Romance or sex tourism?”, a Gambian study and a Costa Rican study describe female sex tourists as usually being middle class and well educated, while the local men are described as young, poorly educated, and from low socio-economic backgrounds, typically working in the informal beach economy, exchanging sex part-time. The majority of the beach boys in the study were in their early-thirties and did not have regular employment.
In comparison with the IBBS done in 2015, there is an increase in condom use with casual partners, tourists and during transactional sex, and an increase in testing for HIV. However, ever being tested for HIV was reported by 35.3% of the beach boys in 2018, which indicates sub-optimal testing coverage. Additionally, only a smaller percentage of beach boys raised the topic of HIV with any of their sexual partners in the 2018 sample compared to the 2015 sample.
Adequate knowledge of HIV is important concerning HIV testing. A South-East Asian, Sub-Saharan African, and Western Australian study, a Spanish study, and a Brazilian study found having low HIV knowledge and low-risk perception to be a barrier to HIV testing. Those who did not use a condom at the time of last sex with tourists were less likely to be tested for HIV, which may reflect the lack of awareness of condoms as a means of HIV protection or the low perception of the risk of HIV.
In such settings where HIV testing is sub-optimal, healthcare providers should take every opportunity to reinforce information about HIV transmission and prevention, and the benefits of early HIV diagnosis and the early initiation of antiretroviral therapy as such might empower beach boys to make more appropriate decisions regarding HIV testing.
The WHO's “Consolidated guidelines on HIV testing services for a changing epidemic” points out that the availability of HIV self-testing, may also help to break down barriers to testing, such as inconvenience and concern about confidentiality, and in turn encourage more regular testing. A Sub-Saharan African study explained that testing in communities where beach boys reside can be done during outreach activities at hotspots in mobile vans, and during sporting and entertainment events. Another Sub-Saharan African study notes that workplace testing might also be an effective strategy to reach employed beach boys and offer them HIV testing and other prevention services. As the majority are in some form of employment, they can be provided with HIV interventions through an occupational-health approach.
The non-availability of condoms was mentioned by respondents as the main reason for not using condoms during transactional sex. This can be addressed by providing condoms through local health-service delivery points, tea shops, hotels, and general stores in conjunction with the implementation of awareness raising activities. It is important that targeted and effective interventions based on a combination of behavioural, biomedical, and structural approaches are kept sustainable and continue to be scaled up.Promiscuous Galle beach boys run high risk of HIV infection
02 Nov 2022
Promiscuous Galle beach boys run high risk of HIV infection
02 Nov 2022
BY Ruwan Laknath Jayakody
Even though the human immunodeficiency virus (HIV) epidemic among beach boys in Galle is still at a low level, there are multiple and overlapping risks for HIV transmission due to increasing travel to Sri Lanka from countries and population groups with a higher prevalence of HIV, and other sexually transmitted infections (STIs), and exposure to contexts that may amplify risks, including HIV-related risky behaviours associated with female tourists, thus creating a priority for HIV-related interventions.
These observations were made in a research article on “Beach boys in Galle: Multiple HIV risk behaviours and potential for HIV bridging” which was authored by I. Bozicevic (attached to the World Health Organisation’s [WHO] Collaborating Centre for HIV Strategic Information, University of Zagreb School of Medicine, Croatia), and A. Manathunge, S. Beneragama and C. Gadjaweera (all three attached to the National Sexually Transmitted Disease [STD]/Acquired Immunodeficiency Syndrome [AIDS] Control Programme, Ministry of Health) and published in the BMC Public Health journal in October, 2020.
The “Country HIV factsheets” of the Joint United Nations Programme on HIV/AIDS estimated that 3,500 (3,000-4,100) persons aged 15 years and above were living with HIV in Sri Lanka at the end of 2018, and that the HIV prevalence among those between the ages of 15 to 49 years was over 0.1%. In 2018, 350 cases of HIV were reported, per the Ministry's National STD/AIDS Control Programme's “Annual report 2018”. In the period between 2011 and 2018, the number of reported cases increased from 78 to 285 in men, respectively, while around 60 cases were annually reported in women.
The Ministry's National HIV Strategic Plan for Sri Lanka for 2018-2022 identifies female sex workers, men who have sex with men, transgender persons, beach boys (defined as men who work or socialise on tourist beaches or close to beaches, and who offer sex to men and women in exchange for money or some form of gratification, and many of whom work in the tourism industry, in restaurants, hotels, guest houses, and boat related tourism), people who use drugs and people who inject drugs as key populations for HIV transmission.
Bozicevic et al. conducted a round of the integrated bio-behavioural survey (IBBS) from March to June 2018, using respondent driven sampling among beach boys in Galle in order to determine the prevalence of HIV, syphilis and herpes simplex virus type-two (HSV-2), corresponding risk behaviours and the utilisation of HIV prevention services.
Galle is a coastal City in the South-West with a rapidly growing tourism industry. During 2018, per the Tourism Development Authority's “Annual statistical report 2018”, out of the total 12,608,044 foreign-tourist nights in graded accommodation establishments, 4,521,094 (35.9%) were in the Southern coast resort region.
M.A. Bellis, K. Hughes, R. Thomson and A. Bennett's “Sexual behaviour of young people in international tourist resorts” and S. Hawkes and G. Hart's “The sexual health of travellers” mentions that international tourists are more likely to engage in risk related sexual behaviours when outside their own community. R. Vivancos, I. Abubakar and P.R. Hunter's “Foreign travel, casual sex, and STIs: Systematic review and meta-analysis” showed that casual sex while travelling is relatively common, although this varies by the country of residence, destination, and nature of travel. A British study noted that 9.2% of men and 5.3% of women reported new sexual partners while being abroad in the preceding five years.
The criteria for inclusion in the survey 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.
The questionnaire was completed in a face to face interview and included questions regarding their social network sizes (assessed as the number of beach boys that the participants know by name, are older than 18 years, live in Galle, and whom they have seen in the past month), and HIV testing history (the receipt of at least two out of the following HIV prevention services from a non-Governmental organisation or a health care provider in the past three months, namely, condoms and lubricants, counselling on condom use and safe sex, and testing for STIs), among others.
Key indicators that were considered were knowing the HIV status from a HIV test, condom use at the time they last had sex with a casual partner, coverage with HIV prevention programmes, discriminatory attitudes towards people living with HIV and age.
A total of 373 beach-boy respondents were recruited in Galle from February to May, 2018.
The median (the middle number or centre value in a data set) network size (the number of beach boys older than 18 years who live in Galle that the participants knew and met in the past one month) was 13 (range: two-50).
The median age of the beach boys in Galle was 30 years (range: 18-72 years). A total of 61.8% of the respondents had regular work while 31.5% had occasional work and 6.2% were unemployed. Almost a half of the participants were married (49.6%), while 45.7% were single, and 4.7% divorced, separated or widowed. All respondents were born in Sri Lanka and Galle was the District of residence in the year before the survey for the vast majority. Never attending school was reported by 2.4%, while 49.6% had completed primary school, and 48% of the participants had completed secondary school education.
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%). In the seven days before the survey, beach boys reported a median of two sexual partners (range: zero-20), while in the 12 months preceding the survey, they had a median of six partners (range: 1-50).
Ever having anal sex with another man was reported by 16% and ever injecting drugs by 2.9%.
For one in four beach boys, the last sexual intercourse with a tourist was unprotected, and the commonest explanations given for this were the non-availability of condoms (51.9%) and thinking that condom use was not necessary (42.1%).
In terms of sexual relationships with tourists, among married beach boys (152), 83.7% have only female tourists as partners, 6% only male tourists and 10.2% both male and female tourists. Among the never-married and single (156), 75.7% reported having only female tourists as partners, 7.9% only male, and 16.4% both male and female tourists. Those who were divorced, widowed, or separated reported only female tourists as partners.
About one-third (39.7%) ever received money, goods or services in exchange for sex, and the majority (94.7%) did so in the 12 months before the survey. For a majority of the beach boys that sold sex, the last paying partner was a tourist (85.5%) and a woman (82%). Tourists that beach boys had sex with in the 12 months before the survey were most frequently from Germany, Russia, France, and Thailand. The amount of money typically received in exchange for sex was $ 21.
In the past 12 months before the survey, 32.3% of the beach boys were paid money for sex, and the majority (99.5%) did so from women.
Compared to the first IBBS carried out in 2015, certain HIV related behavioural and prevention indicators significantly improved in 2018, such as condom use at the time of last sex for which money was received, and testing for HIV. In contrast to these improvements, the proportion of beach boys who reported not knowing the HIV status of the last casual partner increased in 2018 when compared to 2015.
Approximately one in three respondents (38.4%) correctly identified both the ways of preventing the sexual transmission of HIV, and rejected major misconceptions about HIV transmission.
Somewhat more than a half of the participants (58.3%) do not consider themselves to be at risk of HIV, while 31.4% said that they could not estimate whether or not they were at risk. Only 7.3% estimated their risk to be moderate or high.
Ever being tested for HIV was reported by 35.3, and 69.1% of those were tested in the six months before the survey. Of those tested, 94.5% indicated a negative test result while the others reported not getting a test result. The majority of the respondents (94%) were last tested for HIV at a governmental STI clinic. Between 2015 and 2018, the uptake of HIV testing among beach boys increased substantially.
The commonest reasons given for not testing for HIV were the lack of time (45%), and not being at risk of HIV (32.9%), followed by an inconvenient testing location (16%).
Overall, coverage with HIV prevention among beach boys was 14.7%.
Significantly lower odds of never testing for HIV were found among beach boys who demonstrated the most comprehensive knowledge about HIV compared to those with at least one incorrect answer on the knowledge related questions, and higher odds among those who did not use a condom at the time of last sexual intercourse with tourists for which they were paid compared to those who did use. Marginally lower odds of never testing for HIV were found among those with more than two partners in the past 12 months.
One person was found to be positive for HIV, giving a HIV prevalence of 0.3%. Particular antibodies were detected in 0.5% (0.0–1.2%) while only one person had a weakly reactive particular test result suggestive of an active syphilis infection while HSV-2 antibodies were found in 5% (2.5–7.5%).
This study demonstrates the still low level of HIV and syphilis prevalence among beach boys in Galle but a high level of sexual risk taking in a variety of contexts and relationships. HSV-2 prevalence was also relatively low.
E.E. Freeman, H.A. Weiss, J.R. Glynn, P.L. Cross, J.A. Whitworth, and R.J. Hayes's “HSV-2 infection increases HIV acquisition in men and women: Systematic review and meta-analysis of longitudinal studies” and a Middle Eastern and North African study pointed out that HSV-2 serology is a powerful marker of sexually risky behaviour and that therefore, it should be a standard component of HIV surveillance surveys in such a low-level HIV epidemic setting.
Another finding was that beach boys may be acting as a bridge for HIV transmission between higher-risk groups (paying female tourists, and men who have sex with men) and the lower-risk heterosexual female population in Sri Lanka. This is supported by the finding that up to 16% of the married beach boys have sex with both male and female tourists. A.L. Bowring, V. Veronese, J.L. Doyle, M. Stoove, and M. Hellard's “HIV and sexual risk among men who have sex with men and women in Asia: A systematic review and meta-analysis” elaborates that some of these beach boys might be behaviourally bisexual due to the stigmatisation of homosexuality, and social norms and expectations to marry, as found in many Asian countries, while a Vietnamese study, F. van Griensven and J.W. de Lind van Wijngaarden's “A review of the epidemiology of HIV infection and prevention responses among men who have sex with men in Asia” and the WHO’s “HIV/AIDS among men who have sex with men and transgender populations in South-East Asia: The current situation and national responses” emphasise that some may be primarily attracted to women but have situational sex with men due to financial gain or experimentation.
A third of the beach boys reported selling sex to female tourists in a year before the survey while one in four did not use a condom at the last time of transactional sex with tourists. Sexual relationships between local men and tourist women are typically relationships between individuals who are unequal in terms of economic power. A Caribbean study observes that the complexity of these power relations and different expectations that partners in these relationships may have, may lead to lower condom use. K. Ragsdale, W. Difranceisco, and S.D. Pinkerton's “Where the boys are: Sexual expectations and behaviour among young women on holiday” and J.S. Taylor's “Female sex tourism: A contradiction in terms?” suggests that some women holidaying in developing countries may have expectations of longer-term romantic relationships while some travel explicitly for sex. E. Herold, R. Garcia, and T. Demora's “Female tourists and beach boys: Romance or sex tourism?”, a Gambian study and a Costa Rican study describe female sex tourists as usually being middle class and well educated, while the local men are described as young, poorly educated, and from low socio-economic backgrounds, typically working in the informal beach economy, exchanging sex part-time. The majority of the beach boys in the study were in their early-thirties and did not have regular employment.
In comparison with the IBBS done in 2015, there is an increase in condom use with casual partners, tourists and during transactional sex, and an increase in testing for HIV. However, ever being tested for HIV was reported by 35.3% of the beach boys in 2018, which indicates sub-optimal testing coverage. Additionally, only a smaller percentage of beach boys raised the topic of HIV with any of their sexual partners in the 2018 sample compared to the 2015 sample.
Adequate knowledge of HIV is important concerning HIV testing. A South-East Asian, Sub-Saharan African, and Western Australian study, a Spanish study, and a Brazilian study found having low HIV knowledge and low-risk perception to be a barrier to HIV testing. Those who did not use a condom at the time of last sex with tourists were less likely to be tested for HIV, which may reflect the lack of awareness of condoms as a means of HIV protection or the low perception of the risk of HIV.
In such settings where HIV testing is sub-optimal, healthcare providers should take every opportunity to reinforce information about HIV transmission and prevention, and the benefits of early HIV diagnosis and the early initiation of antiretroviral therapy as such might empower beach boys to make more appropriate decisions regarding HIV testing.
The WHO's “Consolidated guidelines on HIV testing services for a changing epidemic” points out that the availability of HIV self-testing, may also help to break down barriers to testing, such as inconvenience and concern about confidentiality, and in turn encourage more regular testing. A Sub-Saharan African study explained that testing in communities where beach boys reside can be done during outreach activities at hotspots in mobile vans, and during sporting and entertainment events. Another Sub-Saharan African study notes that workplace testing might also be an effective strategy to reach employed beach boys and offer them HIV testing and other prevention services. As the majority are in some form of employment, they can be provided with HIV interventions through an occupational-health approach.
The non-availability of condoms was mentioned by respondents as the main reason for not using condoms during transactional sex. This can be addressed by providing condoms through local health-service delivery points, tea shops, hotels, and general stores in conjunction with the implementation of awareness raising activities. It is important that targeted and effective interventions based on a combination of behavioural, biomedical, and structural approaches are kept sustainable and continue to be scaled up.Kapruka
Discover Kapruka, the leading online shopping platform in Sri Lanka, where you can conveniently send Gifts and Flowers to your loved ones for any event. Explore a wide range of popular Shopping Categories on Kapruka, including Toys, Groceries, Electronics, Birthday Cakes, Fruits, Chocolates, Automobile, Mother and Baby Products, Clothing, and Fashion. Additionally, Kapruka offers unique online services like Money Remittance, Astrology, Medicine Delivery, and access to over 700 Top Brands. Also If you’re interested in selling with Kapruka, Partner Central by Kapruka is the best solution to start with. Moreover, through Kapruka Global Shop, you can also enjoy the convenience of purchasing products from renowned platforms like Amazon and eBay and have them delivered to Sri Lanka.Send love straight to their heart this Valentine's with our thoughtful gifts!
Discover Kapruka, the leading online shopping platform in Sri Lanka, where you can conveniently send Gifts and Flowers to your loved ones for any event. Explore a wide range of popular Shopping Categories on Kapruka, including Toys, Groceries, Electronics, Birthday Cakes, Fruits, Chocolates, Automobile, Mother and Baby Products, Clothing, and Fashion. Additionally, Kapruka offers unique online services like Money Remittance, Astrology, Medicine Delivery, and access to over 700 Top Brands. Also If you’re interested in selling with Kapruka, Partner Central by Kapruka is the best solution to start with. Moreover, through Kapruka Global Shop, you can also enjoy the convenience of purchasing products from renowned platforms like Amazon and eBay and have them delivered to Sri Lanka.Send love straight to their heart this Valentine's with our thoughtful gifts!