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(2020)ThesisA significant amount of research suggests that excess weight gain can increase the risk of developing some non-communicable diseases (NCDs), such as diabetes and cardiovascular diseases. In 2014, a screening project organised by the Western Melbourne Regional Development Australia noted that 68% of Australian residents of African ancestry were overweight, obese or morbidly obese, which was higher than the national average of 61.3%. Previous studies indicate that post-migration changes in dietary and physical activity behaviours may contribute to these weight-related issues. However, there is a dearth of research examining the factors associated with dietary and physical activity behaviours among Australian residents born in sub-Saharan Africa (SSA). Given the adverse health implications associated with excess weight again, it is important to investigate the dietary and physical activity behaviours of Australian residents born in SSA, to inform appropriate health promotion policies and interventions. This study examined factors associated with post-migration dietary and physical activity behaviours among Australian residents born in SSA. The study employed a mixed-method approach, comprising in-depth qualitative interviews and quantitative surveys. Using the Australian states of New South Wales and Victoria as the study setting, a quota sampling strategy was used to recruit 24 participants for the in-depth interviews, and a total of 253 respondents were recruited for the survey. Overall, the findings indicate significant changes in dietary and physical activity behaviours after participants settled in Australia. To a large extent, the post-migration changes in dietary and physical activity behaviours reflect less healthy behaviours and can put participants at serious risk of weight-related NCDs. Multiple interrelated factors, comprising acculturation, socio-demographic factors (e.g. age, duration of residence in Australia, rural or urban residency before immigration, and unemployment), environmental factors (e.g. availability and affordability of traditional African food and physical activity products), cultural factors (e.g. cultural beliefs about body sizes), and social-cognitive factors (e.g. attitudes and behavioural intention), were significantly associated with the reported changes in behaviours. It is, therefore, important to develop nuanced health promotion interventions to address the factors associated with the less healthy dietary and physical activity behaviours reported among this under-researched population.
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(2021)ThesisDrawing on Karen Barad’s agential realism and the lens of citizenship, this thesis explores the lived experiences and attitudes of Lebanese, Indian and Anglo LGBTQ+ young adults living in Sydney, Australia. Data collection and analysis were based on qualitative in-depth narrative interviews (n=42) and optional follow-up photo-elicitation interviews (n=20). Participants’ responses, analysed abductively, were framed along broader themes of moral, cultural and sexual citizenship, each further contextualised using aspects of Barad’s theorising: diffraction, time and agency. The thesis has three main findings. First, ‘Australianness’ was predicated on a form of Whiteness that is linked to colonial history and disenfranchisement of First Nations peoples, with consequences for social participation, inclusion within LGBTQ+ communities, and sexual citizenship. Second, heteropatriarchal community values, material culture, religion and spatiotemporal geographies were found to be key factors that influenced young adults’ connection with their cultural communities. Third, the attainment of – or limits to – sexual citizenship and participation was found to be a collaborative endeavour created by an entanglement of formal and informal policies, everyday experiences and material factors. While intersections along the lines of ethnicity, gender, financial ability, locality, disability and so on influenced participants’ participation in domains of everyday life, employing a Baradian framework revealed that young people were far from passive subjects in their social environments and often found ways to explore various aspects of citizenship through an ever-evolving entanglement of agencies. The thesis concludes by arguing that key to the realisation of more just and promising futures and more embracing notions of youth citizenship is the attention paid to relations between belonging, hope and flourishing, which shape, and are shaped by, valences of moral, cultural and sexual citizenship.
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(2021)ThesisThis study takes a deliberate strengths-based approach to identify the sources of sexual health information accessed by Aboriginal young people from one community in Western Sydney, and the role of technology in their information seeking. The research design draws on Aboriginal Ways of Knowing, Being and Doing (Martin & Mirraboopa, 2003) to position Aboriginal young people’s knowledge and experiences as central to the research as participants, peer interviewers and ultimately peer researchers. The research methods were qualitative; peer-led interviews with 23 Aboriginal young people in Western Sydney were conducted. Peer interviewers were selected in consultation with members of a local Aboriginal community. Three male and five female interviewers were selected to ensure that cultural expectations were met regarding the need to discuss issues around sexual health with a person of the same gender. The findings showed that participants used the internet to access information about physical symptoms because searching for information online allowed privacy. Participants then approached trusted sources, including those with whom they had formal relationships (doctors, teachers, counsellors) and informal relationships (family members, friends), to check that the information participants found online was correct and trustworthy. In this context young people used the internet as a triaging tool. The participants were also aware that their formal sources of help and advice, such as teachers, might have to undertake mandatory reporting if certain subject matter were discussed, although the parameters around this obligation and their understanding of which particular professionals were required to do so were not always clear. The research findings therefore have important implications for how sexual health education programs for Aboriginal young people living in urban areas should be targeted.
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(2022)ThesisThis study used mixed-methods design to explore BBVs/STIs risk and protective practices among international students in Sydney from East Asian and sub-Saharan African countries and territories, before and during the COVID-19 pandemic. Semi-structured interviews were conducted with twenty international students from East Asia (N=10), and sub-Saharan Africa (N=10) to explore sexual practices, and the socio-cultural factors shaping these practices. Additionally, an online anonymous survey (N=149) was conducted to investigate BBVs/STIs protective practices and their predictors. Semi-structured interviews were also conducted with sixteen international students from East Asia (N=7), and sub-Saharan Africa (N=9) to explore how the COVID-19 pandemic impacted BBVs/STIs risks. Qualitative data were analysed using reflexive thematic analysis method while quantitative data were analysed using logistic regression model at 0.05 alpha level. Analysis of the interviews data revealed that participants perceive sexual norms in Australia as permissive and casual. In line with sexual script and social norm theories, some participants indicated that it is near impossible to maintain sexual abstinence norm in Australia. Interestingly, some participants hold the view that BBVs/STIs are rare in Australia. This perspective could impact BBVs/STIs risk practices as indicated in interviews data around condomless sex. Condomless sex was a common BBVs/STIs risk practice among participants who are sexually active in Australia. Factors shaping this practice include curiosity, condom-related stigma, alcohol use, seeking greater intimacy and pleasure, and gender stereotypes. Findings from the quantitative data showed that sexual acculturation was the only modifiable predictor of BBVs/STIs protective practices (OR = 0.883, 95% CI = 0.820–0.952). Thus, participants with greater acculturation were less likely to report BBVs/STIs protective practices. Moreover, findings from the qualitative data indicated that pre-COVID BBVs/STIs risks were elevated by the COVID-19 pandemic among some sexually active participants. The findings of this thesis provide evidence for contextualised sexual health services for international students from more conservative cultures. Such services should be cognisant of perceptions around sexual norms with the aim of supporting international students to manage migration-related changes in their sexual practices in a safe manner. Additionally, it is vital to address structural barriers to reduce risk, and strengthen BBVs/STIs protective practices among this population.
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(2022)ThesisFrom the turn of the century, social attitudes have shifted away from secrecy and anonymity in donor conception in line with broader recognition that children have a right to accurate information about their identity and family. As such, some donor-conceived people are now growing up in families who disclose and discuss donor conception openly while others are unexpectedly learning of their donor-conceived status later in life. Yet, little empirical research has explored the array of actors, processes and technologies that shape experiences of belonging for donor-conceived people. This thesis reports on exploratory research of Australian donor-conceived adults’ experiences. The project adopted an innovative interdisciplinary approach, combining methods and analytic techniques from sociology, social semiotics and media studies to explore everyday social, linguistic and digital practices. Data comprise Hansard from a public hearing of a Senate Committee Inquiry into donor conception; a national online survey with sperm donor-conceived (n=90) and egg donor-conceived (n=1) respondents over 16 years of age; and semi-structured interviews with sperm donor-conceived adults (N=28). The research is also underpinned by vignettes of personal experience to reflexively foreground my own positionality as a donor-conceived person. Findings reveal the significant role that digital technologies play in donor-conceived people’s everyday lives. Donor-conceived peers used digital platforms to exchange experiential knowledge and negotiate meanings ascribed to their collective identity, to educate (prospective) recipient parents and the general public about their perspectives, to trace family members through direct-to-consumer DNA testing, and to strategise for increased recognition in legislation. In terms of family, participants navigated complex and dynamic familial (non) relationships and the lingering consequences of anonymity. However, donor-conceived people also found strategies to help them reckon with secrecy and silence, actively responding to social conditions and challenging the institutions of medicine and the law. Indeed, donor-conceived people drew on experiential and institutional knowledges to position themselves as an authority on donor conception as people with lived expertise. I argue that belonging, for donor-conceived people, is experienced across three planes: in relation to peers, family and the State. In doing so, this thesis underscores how everyday belonging is relational and processual, and achieved through a range of momentous events, everyday encounters and humorous artefacts.
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(2022)ThesisHIV pre-exposure prophylaxis (PrEP) is a recent, yet significant, development in HIV prevention. This mixed-methods research followed PrEP’s introduction in Australia, and examined how gay, bisexual and queer (GBQ) men in relationships have adapted to and incorporated PrEP in their sex practices, relationships, and everyday lives. As PrEP raises the prospect of having condomless sex both within and outside primary relationships without risking HIV infection, this research revisited the concept of negotiated safety (Kippax et al., 1997) to explore how HIV-negative GBQ men practice and negotiate safe sex in the era of biomedical HIV prevention. Quantitative data were collected in two national cross-sectional survey projects, The Gay Community Periodic Surveys (GCPS; 2013–2018) and the PrEPARE Project (2013–2021). The GCPS analysis showed a rapid shift away from relationship agreements in which condomless sex is only sanctioned between regular partners. The PrEPARE Project analysis found that men in relationships who used PrEP were more likely to have spoken and non-monogamous agreements, and to have partners that also used PrEP, compared to men in relationships who did not use PrEP. Qualitative data were generated using semi-structured, in-depth interviews conducted between January and August 2019 with 26 GBQ men in Sydney, Melbourne and Perth. Thematic analysis of these data identified new shared meanings and social practices that were enabled or mediated by PrEP, with an analytic focus on complexity, situatedness, contingency and relationality. Participant accounts illustrated diverse sexual practices and views about risk, but most participants adopted PrEP due to perceived HIV risk from casual sex rather than sex with their primary partners. PrEP complicated views about what counted as ‘safe sex’ and revealed changing understandings and practices of intimacy, pleasure, trust and risk. There was, however, an enduring narrative of individual responsibility to practice effective HIV prevention. Participants diverged in how they discussed and disclosed sexual practices with their primary and casual partners, revealing tensions about what disclosures were believed to be necessary or expected. Together, these quantitative and qualitative data collected as PrEP use became more common refocus attention on the practicality and complexity of relationship agreements among GBQ men.
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(2022)ThesisWith widespread access to combination anti-retroviral therapy (cART) and HIV suppression, life expectancy among people living with HIV (PLHIV) is increasing more than ever. According to UNAIDS, there were 8.1 million older PLHIV (i.e., 50 years of age and over) in 2020 globally. Although HIV-associated dementia has become rare in the cART era, mild neurocognitive impairments remain prevalent among PLHIV (~30% in virally suppressed). With aging, there is an increasing concern that HIV may precipitate neurocognitive abnormal aging because HIV is associated with increased markers of aging (e.g., immunosenescence and hyper-coagulopathy) and multiple age and HIV-related comorbidities (e.g., cardiovascular diseases). Importantly, these comorbidities occur at an earlier age and at a higher rate among PLHIV compared to age-matched HIV-negative persons. Earlier, more severe and more rapidly progressing neurocognitive impairment would have major public health consequences for the millions of PLHIV and the healthcare system. The overarching aim of this PhD thesis is to determine whether having chronic stable HIV infection and suppressive ART is associated with abnormal cognitive aging including premature cognitive aging (HIV and age synergistically/addictively lead to much lower cognitive performance at a younger age compared to controls), accentuated cognitive aging (HIV and age synergistically/addictively lead to much greater prevalence and severity of neurocognitive impairment), and/or accelerated cognitive aging (HIV and age synergistically/ addictively lead to much more rapid progression of neurocognitive impairment). To address these questions, we used a range of scientific methodologies including a systematic review, and several types of advanced statistical analyses using national and international longitudinal cohort data. First, to contextualise the potential public health consequences of cognitive aging in PLHIV, we conducted a narrative review of the burden of established dementia risk factors among PLHIV. We identified that the burden of several major dementia risk factors is much greater among PLHIV than in the general population. Second, we conducted the first-ever systematic review evaluating the current evidence for premature, accentuated and accelerated cognitive aging among PLHIV. We determined moderate evidence for premature cognitive aging and strong evidence for accelerated cognitive aging, while accentuated cognitive aging had not been optimally assessed. Lastly, addressing the previous literature major limitations (low sample size, cross-sectional study design, low proportion of older PLHIV, and inadequate controls/norms), we quantified the profiles of cognitive aging in four longitudinal studies of PLHIV. We demonstrated robust trends for premature cognitive aging among PLHIV compared to age-matched HIV-negative persons. We also demonstrated that older PLHIV had a higher risk for both neurocognitive impairment and neurocognitive decline compared to younger PLHIV, while controlling for normative age effect. These results are indicative of both accentuated and accelerated aging, although our research identified the need for longer-term studies using very large sample size to assess these trends especially in PLHIV older than 70+. Based on these findings, we discussed implications for clinical practice and future research directions.
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(2022)ThesisHIV pre-exposure prophylaxis (PrEP) is a highly effective strategy for preventing new HIV infections. Since 2015, PrEP has been rapidly implemented with gay and bisexual men in Australia. While there is recognition of the importance of optimising the clinical delivery of PrEP, there has been scarce empirical research in Australia documenting how clinicians engage with prescribing PrEP, and minimal international social science research considering how PrEP has (re)shaped clinical practice. In this thesis I explore the role of clinicians in delivering PrEP in Australia. Drawing on the sociology of prescribing, I approach PrEP prescribing as a social practice, and attend to how clinicians anticipate and imagine patients, and how they think and feel about PrEP. This study draws on qualitative methodologies, including findings from semi-structured interviews conducted with clinicians who provide PrEP in New South Wales and Western Australia between 2019 and 2020, and with HIV expert stakeholders across Australia in 2017. Through empirical findings, I consider debates about which types of clinicians are best suited to prescribing PrEP and workforce challenges for providing PrEP in different clinical settings. I analyse clinician imaginaries of PrEP users and broader patient collectives, as well as clinicians’ views on providing PrEP to alleviate different types of ‘HIV anxiety’. I also examine prescribing as an affective clinical practice. I identify recommendations for supporting clinical workforces to improve the implementation of PrEP across Australian communities. This thesis demonstrates how PrEP has transformed HIV prevention for clinicians, requiring them to adapt to new ways of approaching HIV and sexual health. Clinicians develop expertise through routine opportunities to prescribe, and they develop imaginaries about patients and communities through consultations that shape their future interactions with patients. Conversely, a lack of patient demand makes it challenging for general practitioners to develop confidence and competence with PrEP prescribing. Providing PrEP involves the complexity of discussing sex and managing ideas about risk and responsibility, which are persistent challenges for both HIV-experienced and inexperienced clinicians. I argue for the value of sociological perspectives on clinical workforces to support and sustain effective HIV prevention.
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(2023)ThesisThis thesis examines the relationship between bodies, politics, and vaccines. I am writing in the context of a pandemic during which vaccines are at the centre of public, political, scientific and media attention. The pandemic has quite clearly exposed the uncertainties and complexities of vaccine research in practice, and the inadequacy of understanding scientific practices as smooth, universalised and disentangled from social dynamics. This thesis tells the story of vaccines as political material encounters. This framing problematises the technological hubris that reduces medical accomplishments to purely biological terms, and questions reinvigorated calls to separate science from politics. Informed by a science and technology studies (STS) perspective and more specifically feminist sensitivities of STS work, I point to the entangled nature of social and scientific events, and to the non-universality of the subject of medical research. The central claim that I make, and work with, across this thesis is that the indeterminacy of vaccines – their social, political and material contingency – is in fact key to the way in which vaccines work. At a time of heightened concern around the public uptake of vaccines, where heroic narratives of the ways in which vaccines work have come to dominate public discourse, in this thesis I explore the grounds for a humbler disposition toward vaccination. I argue that, understanding the situated material configuration of vaccines and their broader social and political co-production provides a vantage point for reassessing the conditions that enable vaccines to work. This insight allows me to claim that vaccines only exist through the material relations they emerge from. I call these relations ‘encounters’ and my exploration of the indeterminacies of vaccines as a practice of ‘encountering’. Rather than ask what vaccines ‘are’, my thesis askes how vaccines come to matter, how they relate to, and at the same time make and enact, specific ideas of bodies, immunity, health and collectivity. I analyse how vaccines encounter nature through the pathogens they are developed to build protection from; how they encounter multispecies bodies in the laboratory practices that produce them; how vaccines encounter the immune system through the phenomenon of immunological memory; and finally, how vaccines encounter communities of bodies through the phenomenon of herd immunity. For each of these encounters, first I consider how these relations are often understood as neutral, fixed, and predetermined outcomes. Then, a further consideration of their material intricacies and the meanings they enact allows me to expose the political and ethical stakes of these arrangements. Understanding vaccines as encounters, focusing on the situated, material, relational condition of their enactments, will open up the possibility to propose different configurations of these encounters and alternative political and ethical sensibilities related to vaccines as relational technologies of bodies, health and community.
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(2023)ThesisPrisons are a hotspot for blood-borne virus transmission. To control outbreaks of these infections, it is essential to have an in-depth understanding of risk behaviours of inmates and the impact of existing control measures, and also to apply sensitive methods for detection of new infections occurring within prisons. This thesis describes studies in these three domains to understand the spread of hepatitis C infection in the prisons in New South Wales (NSW). The clinical data and blood samples for this work originated from two prospective studies conducted in the NSW prisons: the Hepatitis C Incidence and Transmission Study in prisons (HITS-p) (2005- 2014; n=590) and the Surveillance and Treatment of Prisoners with Hepatitis C (SToP-C) (2015-2019; n=3691). The first study identified a high rate of incident infections in an at-risk cohort and documented outcomes (spontaneous clearance, chronic infection, and re-infection or superinfection), while the second study demonstrated the impact of scale up of direct acting antiviral (DAA) treatment in reducing incidence – that is treatment as prevention. The first project utilised qualitative data obtained from audiotaped interviews with inmates in the HITS-p study to understand contexts and concerns regarding violence and HCV transmission in prison. Concerns regarding violence were identified at the individual level during blood contact; triggering factors such as drug debt were identified at the network level; racial influence at the community level; and legislation such as delayed parole for violence impacted at the policy level. For the subsequent projects near-full length HCV genomes for genotypes 1a and 3a cases from both cohorts were sequenced with Oxford Nanopore Technology (ONT) using previously published protocols. A total of 211 genotype 1a sequences and 282 genotype 3a sequences were generated. Of these, 28 1a and 63 3a sequences were from samples collected within 6 months of the estimated date of infection and are hence referred to as acute infection sequences. Acute infection sequences from samples collected during 2005 – 2015 (the pre-DAA era) and 2016-2019 (the post-DAA era) were used to model the temporal evolution in the size of infected population using previously published Bayesian evolutionary analysis methods. The effective population size modelled with the genotype 3a infection samples, demonstrated a 21% reduction in the size of infected population in 2019 compared to 2014. By contrast, the trend in the genotype 1a samples was static. The SToP-C sequences (from both acute and chronically infected subjects) were used to identify molecularly related infections (clusters), before within-host viral variants were further characterised within these clusters to identify likely direct transmission events (defined as phylogenetic intermingling of within-host variants between two or more subjects). For genotype 1a, there were 131 sequences which formed 51 clusters, and for genotype 3a, 140 sequences formed 61 clusters. Each cluster had 2-4 sequences. Among these, 41 genotype 1a and 39 genotype 3a clusters were analysed for minor variants. Evidence of a direct transmission of a within-host variant was observed in only one cluster. Subjects in 45 (40%) clusters were from the same prison providing preliminary epidemiological support for the transmissions. These studies highlight the high-risk context for HCV transmissions in the prison setting, and the utility of molecular epidemiological tools for surveillance in this closed setting.