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Shana D. Hughes, M.P.H., Ph.D., is an Assistant Investigator at Vitalant Research Institute (VRI) in San Francisco, CA. As an applied medical anthropologist, she often employs qualitative and ethnographic methods to investigate questions raised by clinical or epidemiological data, such as why people engage in particular behaviors, and what those behaviors mean to them. Fundamentally, her research attends to the way notions of risk, identity and relationships—which take shape within personal, socio-cultural, and historical contexts—are implicated in health decisions, with the aim of understanding how this knowledge might be applied to improve health outcomes. Prior to joining VRI, Dr. Hughes was based at the Division of Prevention Science at the University of California, San Francisco, where her research focused mainly on sexual health and HIV prevention. Her research program at VRI investigates donor motivation, with the ultimate goal of developing a nuanced and culturally-informed theory that explains and helps drive life-sustaining blood donations.
Shana D. Hughes , M.P.H., Ph.D. Vitalant Research Institute 360 Spear Street, Suite 200 San Francisco, CA 94105 Click Here for Email Phone: (415) 901-0721 Ext: 310353
In the scholarly literature in medicine and public health, “risk” is often treated as self-evident and objectively verifiable. In contrast, engaging with people’s lived experiences has led me to problematize such constructions. Research on, for example, mixed HIV status within couples, engagement with public health services after a syphilis diagnosis, and online access to HIV pre-exposure prophylaxis, revealed that the meanings people assign to health outcomes and the behaviors required to achieve them are contingent and polysemic. Indeed, these are biocultural phenomena that cannot be adequately understood without reference to cultural and historical context, personal identity, and relationship dynamics. The work I did on blood donation motivations prior to joining VRI was primarily on non-compliant donation, that is, donations made by people who are not technically eligible to donate. This included a qualitative sub-study that was part of Blood DROPS, investigating donation motivations among male donors in the US who reported having had sex with another man (at that time, disclosing this behavior would have resulted in indefinite deferral from donation). I also collaborated with colleagues at the South African National Blood Service to investigate the motivations and contexts associated with blood donations made by people living with HIV and taking antiretroviral medications.
According to a recent report to Congress, the US blood system is “struggling” to meet daily demand for blood and ensure future sustainability of the blood supply (HHS 2020:2). What this means in concrete terms is that life-saving blood transfusions may or may not be available to those who need them, when they need them. In part, this situation has been ascribed to a waning societal commitment to blood donation; younger people are not becoming regular blood donors in the same numbers as previous generations. It has also been attributed to the need to engage more donors of color, to better serve the needs of patients as the US population becomes ever more diverse. The reasons for the current shortfall in new donors and underrepresentation of donors of color are likely many, and not well understood. Unfortunately, “innovative approaches to recruiting blood donors are compromised because of lack of funding and insufficient data about evolving donor motivations and changing social norms” (HHS 2020:2). Thus, formative research on donor motivations and barriers to blood donation comprises a large part of my current portfolio. This work centers the perspectives of donors and potential donors from younger age groups and communities of color, and will also gather data to inform the development of linguistically appropriate and culturally resonant recruitment and informational materials. Studies commencing soon are sited in Bethesda, MD; Memphis, TN; and Arizona.
The experience people have when giving blood may influence whether, and how quickly, they return to donate again. Yet few studies in the US have explored the “donor experience” in open-ended ways, let alone utilizing frameworks that are receptive to the multiple, circumstance-dependent, contradictory meanings likely assigned to encounters that are simultaneously clinical and intimate. Proposed research that has yet to be finalized and sited will pursue an ethnographic understanding of blood donation, as well as investigate the role incentives play in donation decision-making.