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(2004)ThesisPleasure Consuming Medicine investigates the significance of the classification of drugs for conceptions of personhood in the context of consumer citizenship. It examines how drug discourses operate politically to sustain particular notions of personhood and organise bodies. As the normative conception of social life shifts to a discourse of consumer agency and active citizenship, it is argued, drugs come to describe the moral boundaries of a freedom configured around personal consumption. The thesis tracks the parallel rise of two discourses of drug mis/use from the 1970s - a discourse of 'drug abuse' and a discourse of 'patient compliance' - illustrating how these discourses bind personal agency to medical authority through a vocabulary of self-administration. It describes how illicit drugs are constructed as a sign and instance of excessive conformity to consumer culture, and how this excess is opportunistically scooped off and spectacularised to stage an intense but superficial battle between the amoral market and the moral state. Pleasure Consuming Medicine uses a theoretical frame developed from queer theory, corporeal feminism, governmentality studies and cultural studies to explore the political character of drug regimes, tracing some of the ramifications for sex, race, class, and citizenship. Then it turns to the field of gay men's HIV education to conceive some alternative and provisional vocabularies of safety. The thesis develops an argument on the exercise of power in consumer society, with the aim of contributing to cultural and critical understandings of consumption, embodiment, sex, health, and citizenship.
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(2019)ThesisSocio-ecological factors such as poverty and mobility have been linked to HIV transmission in East African fishing communities. Little however is known about the influence of these factors on access to and use of HIV testing, treatment and care. To address this gap, in-depth interviews were conducted with 42 HIV positive fisherfolk and 15 health care providers from two HIV clinics located in two fishing communities in Uganda to identify socio-ecological factors influencing access to and use of HIV testing, treatment and care. Bronfenbrenner’s (1979) ecological systems theory guided the analysis of the above interviews. Informational, instrumental, affiliative and emotional support emerging from micro and mesosystem contexts facilitated access to and use of HIV testing, treatment and care. However, HIV-related discrimination present in these same contexts left some participants less supported in accessing services. Exosystem factors, including partner notification initiatives, facilitated some participants’ access to HIV testing, while occasional disruptions in supplies to clinics constrained the availability of HIV-related care. Macrosystem cultural factors, such as beliefs in traditional healing systems, delayed some fisherfolk’s access to HIV testing, while factors linked to the economic context in fishing communities including fisherfolk’s geographic mobility and poor transport systems regularly constrained access to treatment and care. Despite these difficulties, health service organisational factors were to a large extent successful in facilitating fisherfolk’s access to HIV testing, treatment and care. The effects of enabling and constraining factors and processes operating at each of these levels are identified in the thesis which also includes a diachronic analysis – using selected case studies – of the manner in which individual health and illness trajectories are impacted upon by different combinations of factors over time. Overall, the thesis contributes to a more nuanced, socially located understanding of factors influencing access to and use of HIV testing, treatment and care in fishing communities in Uganda. It highlights the need for programmes and interventions to engage more seriously with structural and contextual factors influencing fisherfolk access to services and support.
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(2017)ThesisTogether, men, masculinities and health comprise an emerging area of research, activism and policy debate. International research on men’s health demonstrates how men’s enactment of masculinity may be linked to their sexual health risk. However, little research to date has explored men’s enactment of different forms of masculinity and men’s sexual health from a social generational perspective. To address this gap, insights from Mannheim’s work on social generations, Connell’s theory of masculinity, Butler’s theory of gender performativity, and Alldred and Fox’s work on the sexuality-assemblage, were utilised to offer a better understanding of the implications of masculinities for men’s sexual health. A multi-site cross-sectional qualitative study was conducted in three cities in Bangladesh. Semi-structured interviews were used to capture narratives from 34 men representing three contrasting social generations: an older social generation (growing up pre-1971), a middle social generation (growing up in the 1980s and 1990s), and a younger social generation (growing up post-2010). A thematic approach was applied to analysis to identify the key issues focused upon in men’s accounts. The analysis revealed generational differences and similarities in the construction of masculinity, in sexual practices and in help and health-seeking practices. Findings show that certain ideals of masculinity were common across all social generations. However, social, cultural, economic and political transformations in Bangladesh have produced significant cross-generational differences and discontinuities. Study findings point to the importance of understanding how the production and enactment of specific forms of masculinity are shaped by education, urbanisation, and globalisation, as well as by the cultural dynamics of religion (especially Islam), work, homosociality, patriarchy and heteronormativity, and how these in turn affect sexual health and health-seeking practices. This thesis contributes to a socially located understanding of masculinities, gender and men’s sexual health from a social generational perspective. It argues for the need to move beyond stereotypical, reductionist, essentialist and binary understandings of men, masculinity, gender and health in the South Asian contexts, highlighting opportunities for new forms of intervention and action to promote men’s sexual health.
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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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(2019)ThesisSince the 1960s, the concept of ‘empowerment’ has featured across anti-discrimination legislation, human rights campaigns and community development and has become increasingly influential in both social work practice and mental health service design and delivery. Despite these developments, this concept is often still considered a ‘buzzword’, and the ambiguity and complexity involved in conceptualising and operationalising empowerment in practice has been highlighted in research. However, this body of literature is mainly contextualised in anglophone and European settings and lacks practitioner accounts of transferring the concept into practice. This thesis presents a mixed methods cross-cultural study undertaken in Hong Kong and Sydney to address this gap. Informed by Systems Theory, methods comprised a critical policy analysis of recent mental health policy in Hong Kong and Sydney, a quantitative e-survey of 83 social work practitioners in Sydney and 80 in Hong Kong, and semi-structured interviews with 26 practitioners and six other key informants (e.g., social work educators) in the two settings. Findings suggest that practitioners’ understandings of empowerment often undergo a process of interacting with key concepts that unpin the contemporary organisation of mental health care. Further, the various influences of policy discourses such as recovery were emphasised across the findings, which cautions against the tokenistic use of emancipatory discourse in policymaking and highlights the importance of a critical assessment of policy problematisations and effects. Participant accounts suggest that more attention should be directed to managing interpersonal dynamics beyond client–practitioner relationships in empowerment-oriented practice. The cross-cultural analysis highlights the importance of cultural reflexivity, focusing on the influences of individuals’ own cultural assumptions in shaping the ways practitioners negotiate challenges in front line practice. Based on these findings, a new framework for understanding interactive empowerment praxis is proposed that highlights several professional abilities which may support practitioners in navigating the challenging process of mobilising social work knowledge in the increasingly complex and uncertain health and social care context. This thesis provides critical insights and recommendations for social work education and research which aim to enhance the creativity and adaptability of social work practice in different mental health settings.
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(2019)ThesisIn Australia over 125,000 people are diagnosed with cancer every year and two thirds of those are expected to survive for longer than 5 years. The multi-faceted experiences of people with cancer are variably subsumed under the umbrella term cancer survivorship. However, what defines cancer survivorship or makes someone a cancer survivor is subject to much debate. This thesis uses an innovative combination of longitudinal interviews, participant-produced photography, and narrative interviews to explore the entanglement of relational, embodied and cultural dimensions of cancer survivorship. Drawing on fieldwork conducted in Australia with 19 participants currently having cancer, I address the contested nature of ontologies of cancer, the dynamics of emotions and morality in lived experience, processes of subjectification and how these are enacted in affective practices situated in space and time. I discuss the findings from this thesis employing relational and processual understandings of social life.
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(2019)ThesisInternationally, the relationship between homelessness and the increased risk of sexual transmission of HIV is well established. However, little is known about the social processes that shape homeless young people’s sexual choices, decisions, and practices in the context of Pakistan. To address this gap, semistructured interviews were conducted with twenty-nine homeless young people (aged 16-25 years old) from Rawalpindi, Pakistan, including nine cisgender heterosexual men, six cisgender heterosexual women, seven cisgender gay men, and seven transgender heterosexual women. Bourdieu's concepts of capital and social practice guided the analysis of interview data. The analysis revealed that participants’ pathways to homelessness were shaped by the decline of their families as a source of social capital including the poverty of the family, the stigma of being transgender or gay, and through experiences of domestic violence and illicit drug use. Once on the streets, participants improvised with the limited resources available to them by drawing on and reciprocating peer support, pursuing casual work and engaging in dance and/or sex work to accumulate needed resources. While sex helped some participants secure physical protection, social and emotional support and money, it carried risks of HIV/STI, violence, degradation, and social marginalisation. Participants were aware of their sexual health risks, but the social obligations of intimate partnerships, financial considerations, and fear of violence from clients collectively produced a context of competing risks, where protection from HIV/STI became secondary to maintaining relationships, income generation, and physical safety. Also, in relation to sex, participants adopted alternative strategies to protect themselves from HIV, including practices like only performing oral sex, post-sex anal douching, using the withdrawal method and adopting specific sexual positions when not using condoms. Nevertheless, these strategies were not always protective and sometimes inadvertently increased their risk of HIV/STI. The study’s identification of structural and contextual forces that shaped young people’s trajectories into street life, as well as their sexual risk-taking, have implications for policy and programs. An integrated health promotion approach that goes beyond the health sector may help to reduce young people's risk of homelessness and HIV/STI in Pakistan. Building healthy public policies, creating supportive environments, strengthening community actions, developing personal skills, and reorienting health services could help to improve young people’s socioeconomic status, which affects their capacity to practise safe sex and relationships.