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NEXUS: Investigating Australian male expatriate, longer-term and frequent traveller social networks, knowledge, and practices in Southeast Asia to understand and respond to HIV and other STI acquisition.

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The issue: Over the last decade, HIV infections have increased in Western Australia amongst Australian men travelling, living and working overseas. Population mobility is a contributing factor with Southeast Asia (SEA) a common location of acquisition for expatriates, longer-term and frequent travellers (ELoFTs). Research points to the existence of strong Australian ELoFT culture and networks outside Australia yet there is little information regarding the local relationships formed by ELoFTs and the effects that culture and social networks have on their health.

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Project summary: Using mixed methods, the research examines the impact of population mobility and migration as drivers of HIV and other STI acquisition amongst ELoFTs to SEA. The project is particularly interested in transnational health practices, knowledge, behaviours and social network processes. The intended outcome is to determine how networks may be harnessed for effective public health interventions to address HIV and other STIs, particularly via peer education and social influence; a cornerstone of Australia’s historical HIV response.

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Relevance for practice and policy: Project findings have contributed to the development of a more cohesive and national response to the issue of HIV and population mobility as it relates to ELoFTs. The research provides the opportunity to develop novel ways of thinking about the application of grounded theory and symbolic interactionism and sense-making about changes to the HIV epidemic and those at risk. NEXUS makes recommendations for further social and intervention research targeting expatriates and frequent or longer-term travellers and provides input into strategies that may be more or less effective for health promotion service delivery.

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Project funding: Department of Health, Western Australia and Department of Health, Northern Territory

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Who is involved? Dr Gemma Crawford, Dr Roanna Lobo, Corie Gray and Karina Reeves. Previous collaborators have included Rochelle Tobin, Dr Kahlia McCausland, A/Prof Graham Brown and Prof Bruce Maycock.

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What progress has the project made?

Contextual Insights: Using symbolic interaction as the theoretical lens, a grounded theory and conceptual model were derived from a systematic literature review; in-depth interviews with ELoFTs; observations of users of an online ELoFT forum and analysis of posts; fieldwork visits to Thailand including setting and venue observations and informal conversations with stakeholders. This component of the project has been finalised with a number of papers in development.

Behavioural Insights: A survey is under development, which will investigate the attitudes, beliefs, knowledge and practices of Australian-born men who have travelled to Southeast Asia in the past 5 years, were born in Australia, and are 18 years of age or older. This survey will be refined through consultation with a group of 10 experts with knowledge of the topic and 10 members of the target population. An ethics application to be submitted to Curtin University Human Research Ethics is currently underway for the development and pilot testing of the survey. The survey will be rolled out nationally via the CoPAHM network. Periodic implementation to the target population will help inform future health promotion strategies and interventions targeting the overseas acquisition of HIV among Australian born men will be better informed and more effective. Data gathered would also be able to be compared with existing information collected from other countries and jurisdictions to further inform our understanding of overseas acquired HIV, particularly in other high-income countries.

Intervention Insights: The project continues to gather and disseminate evidence regarding what works. Two systematic reviews are under development examining peer and social influence interventions for men in high-income countries and public health interventions for ELoFTs from high-income countries. The project is seeking funding to trial an intervention to examine the role of online spaces in providing information and support regarding HIV and other STIs to ELoFTs.

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Project outputs: Selected outputs are listed below. A full list of outputs are listed on the SiREN and Odyssey project pages.

  • 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

  • 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. Int J Environ Res 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 Promot J Austr 27(2): 153-154

  • 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

  • Improving society’s sexual health (February 2020)

  • People on the move: implications for meeting Australia’s 95:95:95 targets by 2022 (April 2019)

  • Mobility drives new HIV epidemic (March 2017)

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Linked projects: Community of Practice for Action on HIV and Mobility (CoPAHM), Odyssey

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