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NEXUS: Investigating Australian male expatriate and long term traveler social networks in Thailand to determine their potential to influence HIV and other STI risk behaviour
2010 - present.
Approved by the Curtin Human Research Ethics Committee (SPH-13-2012).
Ms Gemma Crawford (Curtin University), Professor Bruce Maycock (Curtin University), Dr Roanna Lobo (Curtin University), Dr Graham Brown (La Trobe University).
Mobility is a factor in an increase in the incidence of overseas acquired HIV in Western Australia. South-East Asia is a common place of acquisition, with a number of infections identified amongst Australian male expatriates and long-term travelers. Research has indicated that a strong expatriate culture and networks exist outside of the Australian environment. There is however, a dearth of information regarding the local relationships formed by expatriates and travelers and the effects that these social networks have on their health. The characteristics of those acquiring HIV overseas and the settings of these acquisitions warrant further exploration to develop effective interventions to reduce HIV and STI risk in these contexts. The aim of the research is to investigate whether Australian expatriate social networks can be used to support peer education and social influence interventions to reduce sexual health harms including HIV/STIs.
• To build a deeper contextual understanding of culture and personal behaviour amongst Australian expatriates in Thailand.
• To describe the socialisation process and pathways experienced by Australians (potential new expatriates) interacting with Australian expatriates in Thailand.
• To investigate the roles of Australian expatriates as mentors and potential change agents within expatriate social networks in Thailand.
• To construct a theory explaining the development of social networks amongst Australian expatriates and frequent/longer term travelers, and their capacity to support peer education and social influence interventions to reduce sexual health harms including HIV and other STIs.
• To make recommendations for further research and intervention research targeting expatriates and frequent or longer term travelers, including the application of group and social network analysis research.
WA Department of Health Sexual Health and Blood Borne Virus Program, NT Health and Department of Health, Northern Territory.
SiREN has supported the project via supervision.
Project outputs and impacts
The role of expatriate and long-term traveler networks and their potential to impact health are untested. This is a new area of research which provides the opportunity to develop novel ways of thinking about the application of grounded theory and sense-making about changes to the HIV epidemic and those at risk. The chosen methodology can develop typologies to gain insight into expatriate and traveler behaviour. Further, it can illustrate how to locate and identify champions as change agents to address key health and social issues experienced by expatriates and longer term travelers. The significance of the research lies in its ability to gather contextual data that will inform the development of interventions for HIV and STI risk reduction programs which would significantly contribute to prevention strategies in WA. Exploration of the social networks of expatriates and long term travelers in Thailand including: developing an understanding the expatriate subgroups that exist and the way in which entry into the subgroups occurs; understanding the socialisation process, and perceptions of risk; understanding significant symbols, for examples those with shared meanings that may impact upon risk assessment; may provide findings that assist to develop peer based strategies which may be of use in other locations which experience high rates of overseas acquired HIV.
It will also contribute the body of knowledge regarding social networking and risk behaviour in WA and Australia. The role of social networks and the interaction within and between those networks may provide other opportunities for health promotion and public health interventions including in to mental health and alcohol and other drug use. The research may also provide a possible basis for larger studies based on social network analysis. This study is developing recommendations regarding intervention methods and a better contextual understanding of the target group and their attitudes, knowledge and behaviours that may make them vulnerable for HIV and other STI risk. Project findings have been used to inform the development of a more cohesive and national response to the issue of HIV and mobility as well as a number of subsequent research projects. Travelers continue to be a key priority population in the Australian national HIV strategy and the current study provides context and tangible outcomes for research, policy and practice.
Crawford, G., Lobo, R., Brown, G., Macri, C., Smith, H., Maycock, B. (2016). HIV and STIs amongst expatriates and travellers to low and middle income countries: A systematic review. International Journal of Environmental Research and Public Health 13(12), 1249.
Crawford, G., Lobo, R., Brown, G., Maycock, B. (2016). The influence of population mobility on changing patterns of HIV acquisition: Lessons for and from Australia. Health Promotion Journal of Australia 27(2) 153-154.
Crawford, G., Bowser, N., Brown, G., Maycock, B. (2013). Exploring the potential of expatriate social networks to reduce HIV and STI transmission: A protocol for a qualitative study. BMJ Open, 3:e002581.
Crawford, G., Maycock, B., Tobin, R., Brown, G., Lobo, R. (2018). Prevention of HIV and Other Sexually Transmissible Infections in Expatriates and Traveler Networks: Qualitative Study of Peer Interaction in an Online Forum. J Med Internet Res, 20(9), e10787.
Brown, G., Ellard, J., Mooney-Somers, J., Prestage, G., Crawford, G., & Langdon, T. (2014). 'Living a life less ordinary': exploring the experiences of Australian men who have acquired HIV overseas. Sex Health, 11(6), 547-555. (RELATED MANUCRIPT)
Presentations and Posters
Gray C, Crawford G, Lobo R. 2017. Using a community of practice to facilitate collaborative work in HIV and mobility. Curtin University School of Public Health Seminar. Perth, Australia. (Presentation)
Gray C, Crawford G, Lobo R. 2017. Using online communities of practice to facilitate collaborative work in HIV and mobility. 15th World Congress on Public Health. Melbourne (Presentation)
Crawford G. 2016. Making the healthy choice the easy choice: not that easy. WA Health Translation Networks Public Health and Health Promotion Workshop. Perth, Australia (Invited Presentation)
Crawford G, Lobo R, Gray C, Brown G. 2016. HIV and Mobility in Australia: Road Map for Action update. SiREN Symposium. Perth, Australia (Presentation) https://www.youtube.com/watch?v=PeFgrd_fEm0
Gray C, Brown, Crawford G, Lobo R. 2016. HIV & Mobility in Australia. AFAO HIV & Mobility Forum. Sydney, Australia (Invited speaker).
Lobo R, Brown, Crawford G, Gray C. 2015. HIV and Mobility in Australia: Launch of the Interim Report Card. Australasian HIV and AIDS Conference. Brisbane, Australia (Oral session and posters).
Brown G, Crawford G, Lobo R. 2015. HIV and Mobility in Australia: A Roadmap for Action. Inaugural International Conference on Migration Social Disadvantage and Health. Melbourne, Australia (Presentation)
Crawford G, Lobo R, Brown G, Maycock B, McCausland K. 2014. Australian Travellers, Relationships & Risk: exploring the nexus. HIV & Mobility Satellite. Perth, Australia (Presentation)
Langdon P, Lobo R, Crawford G, Brown G. 2014. HIV & Mobility Discussion Paper. HIV & Mobility Satellite. Perth, Australia (Presentation)
Crawford G, Lobo R, Brown G, Maycock B, Tobin R, McCausland K. Rites & Responsibilities: exploring digital discourse of Australian expats/travellers. 2014. PHAA 43rd Annual Conference: The future of public health: big challenges, big opportunities. Perth, Australia (Presentation)
Crawford G, Langdon P, Lobo R. Fast & Cheap’: travel, HIV and public health responses. 2014. PHAA 43rd Annual Conference: The future of public health: big challenges, big opportunities. Perth, Australia (Poster)
Langdon P, Lobo R, Crawford G. Beyond border control? HIV, migration and public health policy. 2014. PHAA 43rd Annual Conference: The future of public health: big challenges, big opportunities. Perth, Australia (Poster)
Crawford G, Lobo R, Brown G, Maycock B, Tobin R. 2014. Risk, Rites and Responsibilities: Digital discourse among Australian expats and travellers in South East Asia. SiREN Symposium. Perth, Australia (Presentation)
Langdon P, Lobo R, Crawford G. Globalisation, Mobility and HIV: Implications for HIV prevention and care in WA. 2014. SiREN Symposium. Perth, Australia (Presentation)
Crawford G, Langdon T. 2009. Responding to Increases in Overseas Acquired HIV Diagnoses in WA Go West: Australian Health Promotion Association 18th National Conference. Perth, Australia (Presentation)
In the news
Mobility drives new HIV epidemic (March 2017) https://healthsciences.curtin.edu.au/faculty-news/pvc-message-march-2017/feature-hiv-research/
HIV and mobility in Australia: Road map for action. HIV Australia, Vol. 13, No 1. (2015) https://search.informit.com.au/documentSummary;dn=056853325724499;res=IELHEA
Partnerships key to preventing HIV transmission overseas (February 2015) http://www.sciencewa.net.au/topics/health-a-medicine/item/3353-partnerships-key-to-preventing-hiv-transmission-overseas
HIV and Mobile Populations: exploring the complexities (October 2014) http://afaotalks.blogspot.com.au/2014/10/hiv-and-mobile-populations-wa.html
Community of Practice for Action on HIV and Mobility. 2018. HIV and Mobility in Australia: Priorities for Action. Perth: Collaboration for Evidence, Research and Impact in Public Health, Curtin University.
Community of Practice for Action on HIV and Mobility. 2016. HIV and Mobility in Australia: Road Map for Action – Report Card 2. Perth: Collaboration for Evidence, Research and Impact in Public Health, Curtin University.
Community of Practice for Action on HIV and Mobility. 2015. HIV and Mobility in Australia: Road Map for Action – Interim Report Card. Perth: Collaboration for Evidence, Research and Impact in Public Health, Curtin University.
Crawford G, Lobo R, Brown G, Langdon P. 2014. HIV & Mobility in Australia: Road map for action. Australia: Western Australian Centre for Health Promotion Research & Australian Research Centre in Sex, Health & Society