Essential Sexual Health Screenings for PALM Workers: Insights from the Devpolicy Blog

Healthcare remains a major concern for workers in the Pacific Australia Labour Mobility (PALM) Scheme. This includes access to sexual and reproductive health services. In 2023, health officials were alerted to a potential outbreak of sexually transmitted infections (STIs) among PALM workers in the Townsville Hospital area. Our recent study, titled “STI and treponemal serology prevalence in a group of predominantly Solomon Islands PALM workers,” sheds light on this issue.

The PALM Scheme allows thousands of workers from the Pacific Islands and Timor-Leste to work in Australia, mostly in areas like agriculture and hospitality. Currently, about 30,000 PALM workers are in Australia, primarily in New South Wales and Queensland. Previous research highlighted significant health challenges these workers face, particularly regarding access to sexual and reproductive health services.

Addressing the STI outbreak among PALM workers presented unique challenges. Most literature on STIs in their home countries focused on pregnant women, which doesn’t accurately represent the mostly male PALM population. To declare an outbreak, it’s crucial to show a spike in infection rates, yet with limited data, it’s difficult for health authorities to assess the situation properly.

Another hurdle is that PALM workers aren’t eligible for Medicare. Any public health strategy had to be affordable. The response involved collaboration with nib, the approved employer, local doctors, and several health organizations. Details of this process can be found in our project report, also published as a supplement to the study.

Notably, the turnout for screening was remarkable, with 97% of workers volunteering after receiving culturally relevant education. This indicates a strong demand for sexual and reproductive health services among PALM workers, pointing to unmet needs.

Results from the screenings showed high levels of certain STIs. Interestingly, 42% of the workers may have latent syphilis infections, while 6% could have infectious syphilis. There were no cases of HIV, and gonorrhea was rare. However, rates of chlamydia were notably higher than the general Australian population, especially among women, aligning with findings from previous Pacific studies.

Participants denied experiences of sexual coercion or transactional relationships, despite these being common concerns. Most reported having regular partners, but further studies are needed to understand their sexual networks better.

The findings have sparked discussions within the Queensland PALM Workers Health Working Group. One key focus is whether to implement routine health screenings for PALM workers upon arrival in Australia. Given the high participation and positive feedback during the outbreak response, many believe this could help reduce future STI cases and health complications.

There are also discussions about how to handle STI results when workers return home. Some diseases, like Hepatitis B and C, require extensive follow-up that wasn’t feasible during this screening. Experts from the Australian Society for HIV, Viral Hepatitis and Sexual Health Medicine are already working with Pacific nations to enhance testing and treatment programs, which could make it possible to include these diseases in future screenings.

While concerns exist about the risk of reinfection upon returning to their home countries, we propose that entry screening in Australia still holds benefits. It could help prevent the spread of STIs among PALM workers while reducing the chance of transmission back into the Australian community. Addressing these health issues proactively offers a chance to integrate other health promotion activities, including family planning and immunization.

Efforts are being made across Australia by health providers, NGOs, and employers to promote sexual and reproductive health among PALM workers. While many initiatives are of high quality, they must be paired with accessible clinical services for testing and treatment to be effective. Given the Pacific’s higher burden of STIs and BBVs, prioritizing health responses for PALM workers is crucial.

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Australia,Health,Pacific migration,Pacific mobility,sexual and reproductive health,Solomon Islands