OLIVIA Merlen and Diane Leow speak to healthcare professionals and international student advocates about what’s behind the incidences of STIs and unplanned pregnancies among international students.
Talk to any healthcare worker in Victoria, and chances are they would have heard of an international student with an STI. Or an international student who’s had a pregnancy scare. Ask them for statistics and figures, though, and they may come up short.
That’s what a 2011 report for the Multicultural Centre for Women’s Health found. It states “high rates of unplanned pregnancies and abortions are characteristic in the female international student population” and due to unsafe practices, “sexually transmitted infections (STIs) may also be an issue.”
But while most organisations specialising in health for migrants acknowledge these newly arrived students are a high-risk population, the evidence remains anecdotal. This is because “STI notification procedures do not request details about patients’ visa status.”
The report, On Your Own: Sexual and reproductive health of female international students in Australia, was written by Carolyn Poljski, as part of her work as the Centre’ health promotion and project research officer.
In it, she outlines the different factors which put female international students at risk of unwanted pregnancies, notwithstanding the risk of STIs. She also explains the multifaceted approach that needs to be taken.
Without any official statistics, however, it’s difficult to find appropriate solutions for this vulnerable group – though organisations such as the Multicultural Centre for Women’s Health and the Centre for Cultural, Ethnicity and Health are trying.
Limited sexual health literacy
It appears one of the primary factors leading to STIs and unplanned pregnancies is that most students arriving in Australia have limited sexual health literacy – that is they haven’t received sexual health education, or at least not as much as Australians receive (More on this here).
Alison Coelho manages Multicultural Health and Support Services (MHSS), operating out of the Centre for Culture, Ethnicity and Health. The programs intends to prevent the spread of HIV, STIs, blood-borne viruses as well as hepatitis among migrant and refugee populations – and they’ve also been focused on international students as well.
“The biggest thing is that in the countries of origin where students are coming from, they don’t always get sexual education, and not at the same level that we provide here,” she explains.
“And they arrive without that sort of support from their family or their friends that they are usually surrounded with.”
The former director of Student Welfare Services at Trinity College, Dr Felicity Fallon, agrees, saying many students arriving in Australia are often misinformed about sex.
She says she’s come across students who believe all STIs are untreatable, or all STI-related symptoms are AIDS. She even encountered one student whose STI severely impacted her studies and daily life.
We had to send her home because she could no longer function. She could no longer walk, she was in such a bad way, and we had to get her father to take her home.”
As part of the MCH Female International Students (FIS) program, Carolyn Poljski has conducted general women’s health sessions – including on sexual and reproductive health – with the help of bilingual officers.
Out of the 110 female international students who participated, 78.6% said they had received their first exposure to health education in Australia. In general, they also had limited knowledge of sexual health.
“The students that participated in the education sessions didn’t seem to know all that much about Sexually Transmitted Infections,” she says.
Even though it was hard to get the students to participate, the response was very positive, and showed the importance of providing sexual health education sessions to international students – upon their arrival and throughout the course of their study.
“I strongly advocated for mandatory education,” Ms Poljski explains.
“I think it should be available to students during orientation, and the message needs to be reinforced throughout their study period.”
Ms Poljski adds there should also be a peer international student with strong leadership whom they respect to tell them about the value of sexual health education sessions.
This may be useful in light of Dr Fallon’s observation that students are often embarrassed to be seen at sexual health talks.
“I got people who were incredibly embarrassed; and I got some young males who thought it was the biggest joke they’d ever heard,” she says.
When we got more students from mainland China, I had to get people to translate words like ‘sexual intercourse’ and ‘condom’ because they were not English words they had ever come across or had any understanding of.”
To get the message across, Dr Fallon would often turn up at the end of tutorials to reiterate the importance of safe sex.
She says it is important to bring up these issues.
“It show[s] that we [are] not afraid to talk about it,” she says.
“There’s a lot of fear around about these things.
“People don’t want to admit what’s going on, don’t want to tell people what’s going on and just deal with things on their own.”
Low priority for international students
International students have a lot going on when they first arrive in a new country – homework, finding accommodation, part time work or simply trying to adjust to a new environment.
Melbourne University Overseas Students Society’s Vice-president of Education and Welfare Zong Yuan Chuah suggests all this may contribute to students’ lack of awareness about sexual health.
[Students] have a lot of information to absorb when they just arrive at Australia and health issues are probably not at the top of the list of things to worry [about].”
MHSS’s Alison Coelho explains after housing, employment and study, health is given less priority.
“Often their sexual health or even their general health comes in quite late in the stage,” she says.
Multicultural Centre for Women’s Health research and executive assistant Jasmin Chen agrees.
But for those who come from more conservative countries, she feels international students should take advantage of the freedom in Australia to inform themselves and become more aware of safe sex practices.
“For some students, being away from home can be a time of sexual experimentation or sexual freedom,” she says.
“But it is important to be educated so you don’t put your sexual health or the health of your partner at risk.”
Social isolation and sexual violence
Migrating to a new country can be an isolating experience for international students and in some cases, Ms Poljski explains sexual violence may occur in different environments, leading to poor health outcomes.
“Female students resort to relationships where they may be pressured to engage in sexual activity,” she explains.
“These relationships are survival mechanisms for the students because they ease their isolation, their depression and their anxiety that they might experience as result of being away from family and friends abroad.”
Ms Poljski says reinforcing ties between international students and locals would go a long way in making international students less vulnerable to the risks of STIs or to falling pregnant unexpectedly.
If we facilitate social inclusion and include international students in Australian society, and get domestic and international students forming friendships, then they may be less need for female international students to engage in these unhealthy relationships.”
Ms Coelho supports this idea. A report will be released on the Multicultural Health and Support Service website in October 2012 called Responding to diversity: Meeting the sexual and reproductive health needs for international students. In it, the Service identifies the unmet health needs of international students – whether male or female – and how to address them.
“What we have identified in the report is that students are even more at greater risk if they are more isolated,” she explains.
A multifaceted approach
There are so many different factors that make international students vulnerable to STIs and unplanned pregnancies as a result of unsafe sex practices – a lack of sexual health education and awareness, a lack of understanding of the Australian health system or poor access to its services, social isolation, or even that it is just not considered their priority.
But while it is important to address every single one of these factors, Ms Poljski believes sexual health education is one, but not the only solution.
She believes a multifaceted approach should be undertaken to diminish the risks international students are exposed to.
“We need to make the immigration experience as positive as possible for international students,” she says.
She is also calling for more support to international students.
“My concern is that international students are very much left on their own to fend for themselves in this country,” she says.
“And that those key players within the education industry such as universities, landlords and employers, anybody that benefits from international students do not fully exercise if at all a duty of care towards them.”
With 447,487 international students fully enrolled in the year preceding July 2012, Ms Coelho thinks Australia needs to take more responsibilty towards this community.
“One of the things we need to think about is that they are not necessarily transitory, that they are here to stay, and how do we support them better.”