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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)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)ThesisIn recent years, major changes have affected the national response to HIV with people who inject drugs in Indonesia. These include changes in international HIV funding, the dissolution of the National AIDS commission, and a “war on drugs” declared by the Indonesian president in 2015. Set in this national context, this thesis examines the production of HIV risk for men and women who inject drugs in Indonesia; the factors that influence their engagement in harm reduction and HIV testing, treatment and care services; and the everyday strategies and actions instigated by people who inject drugs to enhance health and wellbeing. This study adopted a qualitative study design, and involved in-depth interviews with 36 men and women who inject drugs, and 10 key informants in community-based organisations (CBOs) and government health services. Key findings pertain to the production of HIV risk for people who inject drugs within micro-level social and physical spaces, influenced by macro-level stigmatising community values and criminalising policies; socio-ecological influences that inhibit their engagement in harm reduction and HIV services, including insular lifestyles associated with drug use and stigmatisation within interpersonal relationships with families and friends; the loss of critical community-based support services; and the shift of HIV care to formal government health services perceived as unsafe, with operations constrained by national policies. Yet, people who inject drugs also demonstrate a range of strategies – with support of people in injecting networks, families, CBOs and health services – that enable them to navigate and negotiate restrictive social, physical and policy environments to seek health and wellbeing. This thesis contributes to an emerging scholarship in social science approaches to public health in Indonesia. It draws on an analytic framework that recognises the interpersonal, institutional and contextual influences on people’s health and wellbeing, as well as the important action that HIV affected communities take to enhance their own lives in challenging contexts. The conclusions argue for the adoption of HIV and harm reduction practices and policies that cater to the complex lives of people who use drugs, and help overcome their everyday experiences of criminalisation and stigmatisation that produce risk and inhibit engagement in appropriate support services.
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(2022)ThesisPeople who use drugs have been participating in high level drug policy settings for decades, but little critical work has been done to interrogate ‘drug user representation’ in these highly politicised contexts. The aim of this thesis was to open up this terrain and make a scholarly contribution to understandings of both the theoretical underpinnings and the practices of ‘drug user representation’ in these policy settings. Having done decades of ‘drug user representation’ in these same settings, this thesis provided a unique opportunity for me to critically interrogate the practices involved, their underlying assumptions and the effects of these ‘ways of doing things’ for ‘drug user representation’. This research draws on a range of critical perspectives informed by the “ontological turn” including scholars working across disciplines in poststructuralism, critical feminism, Science & Technology Studies (STS) and posthumanism approaches. A qualitative study design was employed to examine ‘drug user representation’ in high level policy settings (such as the United Nations, Commission on Narcotic Drugs) drawing on documentary sources and semi-structured interviews (n=42) with participants engaged in and involved with ‘drug user representation’ within Australia and internationally. The ontopolitical orientation of the research allowed for a critical focus on questions of representation, performativity, power, and resistances underpinned by a reflexive approach consistent with this orientation. This research shows how, alongside increasing calls for greater involvement of people who use drugs in drug policy processes, dominant discourses and other drug policy practices are constantly working to enact drug user representatives as illegitimate political subjects, even before they get to the ‘policy table’. Despite these negative subjectification, discursive and material effects for ‘drug user representation’, the realities being produced through drug policy practices are not pre-determined and singular but emergent, multiple, and therefore, inherently political, and open to the possibility of being done differently. In the context of these ethico-political implications, this research considers how a greater commitment to caring for ‘drug user representation’ as a neglected and under-valued doing might open up new possibilities for ‘drug user representation’ – what it is and what it might become.
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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)ThesisThis practice-led research project examines the role of site specificity in self-tracking data artworks and installations. I argue that the site-specific contexts of materials and devices used in the physicalisation of self-tracking data (whether in art works or data visualisations) are timely objects of inquiry. In contemporary site-specific installation art, the artwork emerges as a response to complex contexts. Similarly, self-tracking data itself is shaped by a relationship to site – for example, the data recording a specific running route through a neighbourhood. This research proposes that site-specific art practice serves as a way of bringing the contextual aspects of self-tracking data physicalisation into explicit focus. As such, I propose the term data installation for describing an approach to rendering self-tracking that brings into relation data, the exhibition site and materials within installation-based artworks. Through the exhibition of self-tracking data in data installations and artworks, my practice-based research analyses the aesthetic choices of data physicalisation, the relation between physical sites and data, and the site-specific and historical aspects of materials. The project asks how specific exhibition sites and institutional contexts shape the production and display of self-tracking data artworks and installations in response to rapidly changing context of contemporary art. Drawing from feminist critiques of the assumed neutrality and objectivity of technology, my practice-based research focusses on the site-specific aspects of materials within artistic data physicalisation. Feminist critiques of technology emphasise the embodied aspects of knowledge production and the historical, social, cultural contexts that shape the use and production of emerging technologies. The central claim of this project, made through a body of nine artworks across five exhibitions and this accompanying thesis, is that site-specific installation practice serves as a way of situating self-tracking data artworks within the contexts of critical data studies and contemporary art. By bringing materials from a specific site into contact with data from the same site, the project demonstrates how data is situated within specific (and contingent) geographic, historical and temporal conditions. This situated approach to the rendering of self-tracking data acknowledges the relation between site and data, foregrounding the specific aesthetic choices and point of view embedded within self-tracking data art, and in the practice of data physicalisation more broadly.