This Exploratory Research Award (R-21) will identify the specific cultural, social and structural factors that underlie low rates of voluntary blood donation in China. It will contribute to public health programs that seek to increase voluntary donation for the purpose of preventing the transmission of HIV and other blood-borne viruses via the transfusion of contaminated blood from illegal paid donors. This study will also provide data necessary to determine the scope and feasibility of a larger R01 study. The research will occur under the auspices of the UCSF Center for AIDS Prevention, with the cooperation of the Shanghai Academy of Social Sciences. The PI, a medical anthropologist, has expertise in conducting long-term ethnographic research in urban China, and is fluent in Mandarin. Her training in HIV prevention research is complemented by the expertise of three Senior Advisors in blood banking and blood donor research in the US and China, and in the development of international HIV prevention research. Employing in-depth interviews, field observations at blood centers and clinics, family and social network discussions, and secondary quantitative data, the research will explore the salience of six hypothesized cultural, social, and structural factors for shaping blood donation in urban China. Reluctance to give blood may be related to 1) the meanings of a gift, and reciprocity as the basis for kin and social relations; 2) notions of blood as a life force in Chinese medicine; 3) the gendered symbolism of blood and nurturance; 4) public mistrust of clinical procedures and staff training; 5) lack of access and information; and 6) demographic factors. As exploratory research, the project may uncover additional important factors. The study's specific aims are to: 1) examine the relative importance of emic cultural beliefs that may shape blood donation; 2) examine the relative importance of social and structural factors that may facilitate or inhibit donation; 3) advance theoretical and practical public health knowledge of the processes by which motivations and intentions to voluntarily donate blood are formed among urban Chinese; 4) generate data necessary to determine the scope and feasibility of future research. Data collection will occur in Shanghai; overall project oversight and data analysis will occur in San Francisco, CA.