Case 8: Should Race be Listed as a Risk Factor?

Records from the STD clinic at the largest general hospital in Harare, the capital of Zimbabwe, indicates that there are twice as many cases of STD's in the colored population as among the black.¹ For almost all other conditions seen in the hospital's outpatient department the number of cases reflects the percent of each ethnic group in the population. The difference in STD rates remain even socioeconomic status is controlled for.

Dr. Chingana, director of the STD clinic, believes that the difference in rates between blacks and coloreds reflects differences in the biologic susceptibility of each group, though he is unsure of the mechanism. To further validate these findings he designed a survey that will try to link STD symptoms with a variety of risk factors including race and ethnicity. He presented his protocol to his institution's Human Subject's Committee for approval.

One committee member, Ms. Johnson, immediately raised a number of questions. Ms. Johnson is a community representative on the committee, and a member of one of the colored groups that frequent the hospital. She noted that the colored population already suffers from an image that pictures them as promiscuous and lax in using health services. If STD's are found to be more commonly reported in coloreds she feels these deeply held prejudices will be further imbedded. Besides she questions why being colored should make a person more susceptible to STD's. Do the bacteria behave differently in colored? Is their anatomy different? She wants the race and ethnicity question to be taken off the questionnaire.

Dr. Chingana argued that this question is critical to the study. Moreover, it may point to further research that contribute to developing STD control programs for colored groups that might reduce the high rate of infection.

• Do you agree with Dr. Chingana or Ms. Johnson?
• Are race and ethnicity a risk factor and if so, how? Biologically? Behaviorally?
• If ethnicity or race are not recorded, what other differentiating factors might be noted?

Notes

1. Prior to independence, Zimbabwe had a policy that was apartheid-like in its implementation. The population was divided into a variety of racial groups by the state including the following: black, white. colored, and Asian. Categorization was based on a variety of factors including appearance, descent, language, and behavior. An individual can define him or herself as either black, white, colored, Asian, or other. This self categorization can be investigated if some benefit will accrue to an individual because of the designation used.