By Mikaela Seymour and Stefanie Vaccher
In 2023, a potential outbreak of sexually transmitted infections (STIs) among Pacific Australia Labour Mobility (PALM) Scheme workers in the Townsville Hospital and Health Service area brought urgent attention to the sexual health needs of this workforce. Despite healthcare consistently being a top concern for PALM workers and their employers, there remains a significant gap in understanding their specific sexual and reproductive health needs.
The PALM Scheme, a collaboration between Australia and eligible Pacific nations and Timor-Leste, facilitates temporary employment in Australia across various sectors such as horticulture and hospitality. With around 30,000 PALM workers residing mainly in New South Wales and Queensland, the scheme is a critical component of the Australian labor force. However, the recent STI outbreak highlighted the unique challenges in addressing health concerns within this community.
Challenges in Addressing the Outbreak
The outbreak investigation, detailed in a study titled “STI and treponemal serology prevalence in a group of predominantly Solomon Islands PALM workers,” revealed several hurdles. Australian public health units, while experienced in managing outbreaks, faced difficulties due to a lack of baseline data on STI prevalence in the workers’ countries of origin. Most existing studies were based in antenatal clinics, which do not reflect the predominantly male PALM workforce.
Moreover, PALM workers’ ineligibility for Medicare necessitated a financially feasible public health response. This required extensive collaboration with various stakeholders, including nib, the preferred insurance provider, local healthcare providers, and nonprofit organizations. This collaborative effort was crucial in managing the outbreak effectively.
High Participation and Demand for Services
The response to the outbreak was notable for its high participation rate, with 97% of workers volunteering for screening after receiving culturally tailored education from an independent doctor from their country of origin. This high demand underscores the likely unmet need for sexual and reproductive health services among PALM workers.
Unexpectedly high rates of test positivity presented further challenges. The syphilis blood test results were difficult to interpret due to the presence of both Treponema pallidum pallidum and Treponema pallidum pertenue in the Solomon Islands. Discussions with local clinicians suggested that the results likely indicated STI syphilis, given past yaws eradication efforts. The study hypothesized that 42% of the cohort had latent syphilis infections, while 6% had potentially infectious syphilis.
Implications and Recommendations
The findings have prompted several recommendations under consideration by the Queensland PALM Workers Health Working Group. One key consideration is the potential implementation of preventive health screenings upon workers’ arrival in Australia. Such screenings could reduce future STI cases and associated health complications, although a health economist’s input would be necessary to assess cost-effectiveness.
Another concern is the management of STI results when workers return to their home countries, especially for conditions like Hepatitis B and C, which require extended treatment. The Australian Society for HIV, Viral Hepatitis and Sexual Health Medicine is working with Pacific nations to strengthen testing and treatment programs, potentially allowing for the inclusion of these diseases in future screenings.
“Preventive sexual health screening on entry to Australia could offer benefits by reducing BBV/STI transmission within PALM worker cohorts during their stay.”
Broader Health Promotion Efforts
Health insurers, employers, NGOs, and health providers across Australia are engaged in health promotion and education activities targeting PALM workers. However, the effectiveness of these initiatives depends on the availability of accessible and acceptable STI testing and treatment services. Tailored approaches are essential to overcoming the barriers PALM workers face in accessing sexual and reproductive healthcare.
The Pacific region bears a disproportionate burden of STIs and blood-borne viruses, making it imperative to prioritize responses to these issues among PALM workers. Proactive measures, including broader reproductive health education and family planning, can provide lasting benefits to workers and help mitigate the spread of infections.
This article originally appeared on Devpolicy Blog, from the Development Policy Centre at The Australian National University, and is republished here with permission. Dr. Mikaela Seymour and Dr. Stefanie Vaccher, the contributing authors, bring extensive experience in public health and epidemiology in the Pacific region.
