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 Drug Laws and AIDS: A Crisis in the African American Community
Anthony Scott Washington
2nd Year Law Student
The University of Dayton School of Law

December 3, 2001

INTRODUCTION

The criminal justice approach to drug use has contributed to the increasing numbers of African Americans diagnosed with HIV. A significant portion of the AIDS cases in the African American community can be attributed to a slanted and racially biased criminal justice system that disproportionately incarcerates African Americans. Incarcerating drug users, in many cases, means sending people with AIDS to prison.(1)

Most of the people being locked up are African American drug addicts.(2) Thus, blacks are disproportionately in prison creating a heightened risk of HIV infection for sexual partners within prison and in the community following release.(3) The current laws and policies directed toward drug users have severely restricted access to intervention services and drug treatment by diverting money away from treatment and towards punitive methods.(4) Therefore, the impact of anti-drug laws and inadequate intervention and drug treatment have led to increasing numbers African Americans being infected with the HIV virus. This paper will examine the impact of the racially biased criminal justice approach to drug activity; point out its flaws and inadequacies for dealing with the complex problem of drugs in America; and finally, present plausible solutions for a problem that cannot be conquered by locking up hundreds of thousands of African Americans.

Section I, will identify behavior patterns associated with the inner city drug culture that have led to African Americans contracting AIDS at a higher rate than any other group. The inner city drug culture can be identified as a local urban setting that has become overwhelmed by drug activity, where the intersection of drug use and poverty have collided with the forces of history, race, and economic theory.(5)

This collision results in drug activity becoming entrenched in the core the city.(6) Some of the worst affected inner cities have become breeding grounds for this social pathology.(7) Overwhelmingly, the driving force propelling this pathology is drug abuse. The demand for illegal narcotics has created an enormous market and as a result the underground drug economy has become rooted in many inner city neighborhoods.(8) Several factors within the inner city drug culture are responsible for the spread of AIDS within the African American community. These factors include: intravenous drug use and behavior associated with the crack cocaine culture; and equally, if not more important, is the complex issue of African American women within the inner-city drug culture. These factors have resulted in increasingly high rates of transmission among African Americans.

Section II will examine the criminal justice system's approach to drug use and AIDS among African Americans. The "War on Drugs" as declared by the Reagan Administration is best illustrated by a slogan that the Administration adopted; "make them all prisoners."(9) The War on Drugs included law enforcement, treatment, and educational components, but the White House Office of National Drug Control Policy ("ONDCP") loudly proclaimed that emphasis should be given to law enforcement.(10) One sign of the law enforcement emphasis was an ONDCP insistence, year after year, that federal funding be split 70-30 in favor of law enforcement over other programs.(11) Another sign was its persistent refusal to accept a "treatment on demand" approach to drug treatment even when it was known that tens of thousands of drug users in cities wanted but could not gain admission to treatment programs.(12) The War on Drugs was fought largely from partisan political efforts to show that the Bush and Reagan administrations were concerned about public safety, crime prevention, and the needs of victims.(13) This War foreseeably and unnecessarily blighted the lives of hundreds of thousands of young, disadvantaged Americans, especially African Americans, and undermined decades of effort to improve the life chances of members of the urban black underclass.(14) The bodies counted in this war, as they lay in their prison beds, however, are even more disproportionately African American than prisoners already were. War or no war, most people are surprised and saddened to learn that for many years, 30 to 40 percent of those admitted to prison were African American.(15)

 

The question the body politic must answer is whether building jails, prisons, and courthouses is the correct approach to handling those who commit drug offences.(16) Drug prohibition not only imprisons large percentages of African Americans, it also deters drug users from seeking treatment for a myriad of other medical conditions, such as HIV/AIDS.(17) Ironically, the criminal status of drugs even deters drug abusers from seeking treatment for drug addiction.(18)

Section III will lay the analytical framework for the elimination of AIDS in African American community. The repeal of drug laws that sentence nonviolent drug offenders to extensive prison terms where they receive no treatment can effectively reduce the spread of HIV/AIDS in the African American community. Intensive long-term treatment of drug addicts, and closely monitored re-entry programs should replace prison sentences for habitual drug offenders. It is sound public policy to assist recovering addicts become productive members of their communities. The correct approach would be to place these individuals under the care of healthcare professionals rather than wardens and guards.(19) The war on drugs must be fought primarily as a public health war, not a criminal justice war. The goal should be to find the right balance of law enforcement and public health strategy to achieve a common goal, safer communities, healthier individuals, reduced substance abuse, and the elimination of AIDS.(20) The focus will be on four achievable goals: (1) development of education programs to prevent behavioral pathology linked to HIV/AIDS transmission; (2) provide treatment programs for all first time and habitual drug offenders seeking recovery; (3) enact public health policy to deal specifically with African American women with AIDS; and (4) restructure the drug policy from "criminalization to medicalization," through legislation that de-emphasizes incarceration for drug use, and increases public health efforts to combat the spread of AIDS among the poor and disenfranchised. These efforts should include treatment and rehabilitation for all addicts, and a national needle exchange program for those that cannot be rehabilitated.

I. THE INNER CITY DRUG CULTURE AND AIDS

The forces of history and race, economic theory and human vulnerability have conspired to create a new and peculiar universe in the inner cities of this country.(21) This strange dynamic in combination with the availability of illegal drugs has created a subculture within urban America. The "inner city drug culture" is organic and central within the cities of America.(22) Street level drug markets in the inner city are overwhelmingly located in African American neighborhoods; however, many users serviced by these markets are white. More importantly, the proximity of the inner cities to outlying suburbs has made the inner city drug culture exceedingly diverse. The demand for heroin and cocaine on American street corners is decidedly multicultural.(23)

The rules and imperatives of mainstream American culture do not apply within the inner city drug culture.(24) Here, the social norms and culture that reside in the luxury of reasonable judgments are left behind.(25) Social networks of gunners (intravenous drug users); pipers (crack addicts); ballers (drug dealers); and touts and lookouts (middlemen and law enforcement lookouts) exist within the drug culture. Equally as significant are the shooting galleries, crack houses, shanties, shacks, street corner hangouts, abandoned buildings, vacant lots, rooftops, cars, trucks, and public parks; all of which are essential elements of the inner city drug culture.(26) Furthermore, the interactions between drug users and drug distributors, family members, neighborhood residents, and various types of law enforcement personnel, including beat officers, members of tactical narcotics squads, and the Warrant Squad add to the complex dynamic of the inner city drug culture.(27) The apparent evolving nature of the inner city drug culture, and its intersection with poverty and social pathology has created a ripe environment for HIV to flourish.

AIDS, which entered the American society as a "gay plague," has undergone a dramatic transformation from one concentrated primarily among homosexual men to an epidemic that is now closely associated with the inner city drug culture.(28) More specifically, the connection between HIV/AIDS and drug addiction in the African American community is increasing at an alarming rate.(29)

Substance abuse is fueling the spread of HIV in the United States, especially in the African American community. Through December 1999, the CDC had received reports of 733,374 AIDS cases - of those, 272,881 cases occurred among African Americans.(30) Representing only an estimated 12% of the total U.S. population, African Americans make up almost 37% of all AIDS cases reported in this country.(31) Among African American men with AIDS, men who have sex with men represent the largest proportion (37%) of reported cases since the epidemic began.(32) The second most common exposure category for African American men is injection drug use (34%), and heterosexual exposure accounts for 8% of cumulative cases.(33) Among African American women, injection drug use has accounted for 42% of all AIDS case reports since the epidemic began, with 38% due to heterosexual contact.(34) Excluding African American men who have sex with men, two of the most common exposure categories for African Americans are injection drug use, and behavior associated with crack cocaine addiction. Sharing needles and trading sex for drugs are two ways that substance abuse can lead to transmission of HIV. In addition, ingestion methods associated with crack addiction increases the risk of HIV transmission significantly.(35) Further, complicating the issue of HIV/AIDS in the African American community is the complex factors that exist for women that become involved in the inner city drug culture.(36)

A. African Americans, Drug Use and AIDS

High rates of intravenous drug use are among the factors that have accounted for the relatively high rate of new HIV infections among blacks in the U.S.(37) More specifically, bloodborne disease in the drug dependant population disproportionately strikes the urban poor.(38) Thus, HIV disease is an epidemic that disproportionately affects African Americans.

Sharing syringes and other equipment for drug injection is a well-known route of HIV transmission, yet injection drug use contributes to the epidemic's spread far beyond the circle of those who inject.(39) People who have sex with an injection drug user (IDU) also are at risk for infection through the sexual transmission of HIV.(40) Also, children born to mothers who contracted HIV through sharing needles or having sex with an IDU may become infected as well.(41) Since the epidemic began, injection drug use has directly and indirectly accounted for more than one-third (36%) of AIDS cases in the United States.(42) This disturbing trend appears to be continuing.(43) Of the 48,269 new cases of AIDS reported in 1998, 15,024 (31%) were IDU-associated.(44)

Racial and ethnic minority populations in the United States are most heavily affected by IDU-associated AIDS.(45) In 1998, IDUs accounted for 36% of all AIDS cases among both African American and Hispanic adults and adolescents, compared with 22% of all cases among white adults/adolescents.(46) IDU-associated AIDS accounts for a larger proportion of cases among women than among men.(47) Since the epidemic began, 59% of all AIDS cases among women have been attributed to injection drug use or sex with partners who inject drugs, compared with 31% of cases among men.(48)

 

Noninjection drugs (such as "crack" cocaine) also contribute to the spread of the epidemic when users trade sex for drugs or money, or when they engage in risky sexual behaviors that they might not engage in when sober.(49One CDC study of more than 2,000 young adults in three inner city neighborhoods found that crack smokers were three times more likely to be infected with HIV than non-smokers.(50) Research has demonstrated important linkages between crack smoking and HIV/AIDS, especially through increased risk of sexual transmission. Among HIV prevention interventionists and researchers there has been considerable speculation regarding the potential for HIV transmission through the sharing of crack pipes or stems contaminated with blood from smokers' cut and burned lips, or from oral sex performed by crack users with injured lips.(51)

 

The intersectionality of the inner city drug culture, HIV/AIDS, and African Americans is portrayed in the following account. "Jeff" graduated to cocaine during his early twenties after drinking heavily and smoking marijuana throughout his adolescence. He moved from snorting to freebasing (pre-crack) to intravenous use and eventually to smoking crack when it hit the streets of Philadelphia sometime in 1986. Before entering a substance abuse treatment center, he tested HIV positive, which he attributes to his lifestyle while injecting cocaine. Regarding his cocaine use and the powerful effect cocaine had on him, he said: I started snorting in my early twenties while I was in Florida living with my brother. I was turned on to it by a girlfriend. I started smoking coke when I was in Texas when I was 26 or 27. I started shooting at about 30. To me IV use is better than sniffing or smoking. The only problem is sometimes it's hard to get the hit [vein]. I hit myself but I started out with someone else hitting me. To me cocaine makes you numb to the world. You don't care about nobody or nothing. I've gotten high with people and didn't even tell them that I had the virus [AIDS], and on the other hand I've told people and I they still shot up behind me. They didn't care.(52)

 

Drug use and AIDS are problems that have been particularly harmful to the African American community. HIV infection among African American women, present particular problems for the African American community, and add a unique dynamic in the fight to eliminate AIDS among African Americans.

B. African American Women, Drug Use and AIDS

HIV infection in women has a cascading effect.(53) Over the last several years, the face of AIDS has changed rapidly, unleashing a potentially devastating impact on the African American community. Increasingly, AIDS is afflicting women, particularly poor women and women of color. Indeed, if one speaks about women and AIDS today, one is speaking overwhelmingly about African-American women.(54) Women are particularly vulnerable because there are several methods by which transmission can occur. A large percentage of African American women that have been identified HIV positive are intravenous drug users. However, a behavior mode of transmission that is often overlooked is heterosexual sex with men that are covertly bisexual and infected with HIV. Also, women are subject to transmission through sexual contact with intravenous drug users.(55) In the United States, most HIV- infected women are exposed to the virus during sex with an HIV-infected man or while using HIV-contaminated syringes for the injection of drugs such as heroin, cocaine and amphetamines.(56) The account of Macho, an inner city youth illustrates of impact of AIDS on African American women with connections to the inner city drug culture:

My mom, who's dead now, grew up on Knickerbocker Avenue in Bushwick. She died last year [1996], on June 12th, of AIDS. My little sister's father gave it to her and she died 3 months after she was diagnosed with the disease. He had the virus and never said anything to her. Eventually, she began to wonder why she was getting sick all the time and when we found out the truth, she was shocked.(57)

 

During unprotected heterosexual intercourse with an HIV-infected partner, women in general appear to be more easily infected with the virus than men. Studies in the United States and abroad have demonstrated that other sexually transmitted diseases (STDs), particularly infections that cause ulcerations of the mucosal surfaces (e.g., syphilis and chancroid), greatly increase a woman's risk of becoming infected with HIV.(58) Anal sex also increases a woman's risk of becoming HIV-infected.(59) HIV/AIDS has created tremendous difficulties for African American female drug users, who are disproportionately poor and reside in the inner city.(60) he question that legislators must answer is whether the appropriate method for dealing with this delicate dynamic is to look at the female addict as a patient to be treated rather than a criminal to be incarcerated.(61) Dealing with African American female drug users is critical in reducing the spread of AIDS among African American Women.(62) A number of other factors are associated with an increased risk of HIV transmission among African American female drug users, including alcohol use, history of childhood sexual abuse, domestic abuse and use of crack/cocaine.(63)

 

Female crack addicts are particularly vulnerable, since the extreme need for the drug may force them to perform sexual acts for crack or for money. Oral sex is often associated with crack smoking because it is less complex, more manageable, and can be performed quickly in any accessible place.(64) Early studies suggested that the transmission of HIV by oral sex is relatively remote; however, female crack users that perform frequent unprotected oral sex may be at greater risk of HIV infection through mouth trauma (injuries of the lips and mouth) such as cuts from broken glass stems and burns associated with either the heat of the pipe stem or the flame of the butane lighter.(65) These injuries may increase the likelihood that blood and semen contact may occur during oral sex. The potential of HIV transmission may also be enhanced because most women who perform repeated acts of oral sex in crack houses refuse to swallow a customer's semen, thus exposing the lips and mouth to potentially HIV-infected secretions.(66)

 

There are other issues that are unique to the female crack addicts, further underscoring the significance of the African American female crack user. For example, research has suggested that among those who experiment with crack use, women are more likely than men to become addicted, and addiction occurs more rapidly among women than among men.(67) Moreover, crack-dependent women are viewed skeptically because of the sexual promiscuity that is associated with the crack culture, and other factors that carry perils of social exclusion and legal sanction.(68) Thus, some observers have concluded that drugs, and especially crack, have more profound and lasting effects on women than on men, and typically, this intense relationship with crack translates into, or intensifies the African American female crack addict's relationship with the inner city crack culture which frequently manifests itself through sex-for-crack transactions.(69)

 

Adding to the difficulties that African American women experience within the inner city drug culture is the fact that female crack addicts often prostitute themselves in order to support their habit and consequently become infected with the AIDS virus.(70) Even with the AIDS epidemic on the rise there still appears that a strong demand for prostitution, and it continues to be a regular activity, especially in larger urban settings.(71) Street prostitutes are at a high risk for HIV infection and rarely receive AIDS screening or health care treatment.(72)

 

African American women within the inner city drug culture face numerous risk factors associated with HIV/AIDS. With the demographic pulse of American society rapidly expanding, African American women are becoming a more intricate element with the dominant culture. If public health and social policies are not formulated and implemented to address the specific needs of this group, the AIDS epidemic could become the primary health care concern of the twenty-first century. Therefore, drug related laws and policies should dramatically shift to address the needs of specific populations that are increasingly being infected with HIV.

II. AIDS AND DRUG RELATED LAWS AND POLICIES

The current law and policies aimed at reducing the impact of drug abuse and addiction have largely failed to reduce the problems attributable to drug-related HIV/AIDS in the African American community. More correctly stated, the national drug policy has exacerbated the spread of AIDS among African Americans. Drug prohibition is a principal cause of the spread of HIV virus, especially among African Americans.(73) The current drug policy's racially disparate impact has further perpetuated the problems surrounding the increasing numbers of African Americans being infected with HIV.

Drugs have played a key role as to changes in the criminal justice system, particularly the growth in incarceration over the last twenty years. There are now eleven times as many people locked up for drug offenses as there were in 1980.(74) African Americans males compose one-half of the prison population in the United States, despite the fact that they constitute only 5% of the total U.S. population.(75) It appears that current drug policies seek to address drug abuse and addiction by incarcerating large percentages of the African American population, particularly, young black males.(76) During the 1990s there was a dramatic increase in the number of hardcore addicts needing treatment.(77) More importantly, the number of untreated hardcore addicts paralleled this growth.(78)

President Ronald Reagan declared a War on Drugs in 1982. In response, Congress enacted the Sentencing Reform Act (SRA).(79) The Act announced new objectives: (A) to reflect the seriousness of the offense, to promote respect for the law, and to provide just punishment for the offense; (B) to afford adequate deterrence to criminal conduct; (C) to protect the public from further crimes of the defendant; and (D) to provide the defendant with needed educational or vocational training, medical care, or other correctional treatment in the most effective manner.(80)

 

A revolutionary feature of the SRA was its creation of the United States Sentencing Commission, an independent expert panel within the judicial branch charged with refining sentencing.(81) Prior to 1984, the federal government employed an indeterminate system, which entailed a "three-way sharing" of sentencing responsibilities among the branches of government: "Congress defined the maximum, the judge imposed a sentence within the statutory range, ... and the Executive Branch's parole official eventually determined the actual duration of imprisonment."(82) The SRA altered the indeterminate system by delegating authority to the Sentencing Commission to produce guidelines that would promote the SRA's objectives (ensuring certainty in sentencing, eliminating disparity, and providing just punishment).(83) A primary motive for this change was to confirm waning public confidence in the criminal justice system by thwarting "soft" judges who sentenced culpable criminals too lightly; proponents believed they could accomplish this through a compulsory system where "similar offenders, committing similar offenses, would be sentenced in a similar fashion."(84) It was understood that the guidelines would be an evolving, rather than an immediate, fix to the sentencing system.(85) To help achieve the SRA's goals, Congress abolished the federal parole system and made the guidelines compulsory.(86) The Supreme Court deemed Congress' delegation of authority to the Sentencing Commission constitutional in United States v. Mistretta.(87)

Separate and distinct from establishing the Commission, Congress enacted the Anti-Drug Abuse Act of 1986 (ADAA).(88) The ADAA set forth mandatory minimum penalties for federal cocaine traffickers.(89) By doing so, Congress differentiated between the trafficking of cocaine and crack, and provided a much harsher penalty for crimes involving the latter, thereby creating the 100-to-1 ratio.(90) As the guidelines needed to comport with the mandatory minimums, the 100-to-1 ratio set forth in the mandatory minimum statute was incorporated into the federal sentencing guidelines.(91) The ADAA was passed before the Sentencing Commission's first set of guidelines was implemented--and the statutorily mandated sentences were then incorporated into the guideline terms.(92) Justice Breyer, who was a member of the original Sentencing Commission commented that "statutory mandatory sentences prevent the Commission from carrying out its basic, congressionally mandated task: the development, in part through research, of a rational, coherent set of punishments."(93)

Nevertheless, Congress persisted in drawing a greater distinction between crack and cocaine in the Omnibus Anti-Drug Abuse Act of 1988 (OADAA).(94) A significant aspect of the OADAA is that it created a five- year mandatory minimum sentence for a first offense of simple possession of more than five grams of crack. In contrast, "[s]imple possession (without the intent to distribute) of any quantity of powder cocaine by first-time offenders is a misdemeanor punishable by no more than one year in prison."(95) Moreover, simple possession of any other drug is a misdemeanor offense punishable by a maximum of only one year in prison. These offensives in the War on Drugs have led to practical problems and to a racially disparate impact; thus, compounding the problems within the inner city drug culture.(96)

 

Another explanation for the disparate impact has to do with police and prosecutorial discretion.(97) According to one study, which investigated the racial disparity caused by the 100:1 ratio and the mandatory minimum sentencing statutes, blacks made up 42% of all drug arrests in 1991, even though they comprised only 12% of the population.(98) In 1992, blacks were four times as likely as whites to be arrested on drug charges, even though there were only 1.6 million black drug users and 8.7 million white drug users.(99)

 

Judge Clyde S. Cahill, of the United States District Court for the Eastern District of Missouri, found that prosecutorial and police discretion were directly accountable for the disparate impact in crack cocaine cases in the Eastern District of Missouri. "The law enforcement practices, charging policies, and sentencing departure decisions by prosecutors constitute major contributing factors which have escalated the disparate outcome."(100) Out of 57 crack convictions in the Eastern District of Missouri during the 1988-1992 time period, 56 of the defendants were black, and one was described as white/Hispanic.(101) Thus, 98.2% of defendants convicted of crack cocaine charges in the Eastern District of Missouri during this period were black. Judge Cahill also cited national statistics indicating that 92.6% of the defendants convicted of crack violations during 1992 were black, while only 4.7% of the defendants were white.(102)

 

Judge Cahill found evidence of prosecutorial discrimination in two facts. First, he cited statistics compiled by the National Institute on Drug Abuse indicating that only 26.2% (990,000) of the people who use crack are black while 64.4% (2.4 million) are white and 9.2% (348,000) are Hispanic.(103) He contrasted this with the fact that 98.2% of the people convicted of crack offenses in the Eastern District of Missouri were black and concluded that the radical difference between the two percentages could only be explained by law enforcement officers and prosecutors targeting black crack traffickers for arrest and prosecution.(104)

As a result of the slanted and racially biased criminal justice approach to illegal drug use, the numbers of African Americans under the jurisdiction of the criminal justice system is almost too startling to state. The U.S. Justice Department reported in 1990 that more than 1.5 million African Americans were then either in jail or prison, on probation, or on parole.(105) Other reports, which focus specifically on urban cities, find that black males fare even worse. For example, in Baltimore, Maryland, 56% of black males between 18 and 35 are under the supervision of the criminal justice system.(106) Ironically, black males in the United States are incarcerated at a rate four times that of black males in South Africa: 3,109 per 100,000, compared to 729 per 100,000.(107) The high rate of incarceration of African-American males is having a devastating impact on African-American communities and families.(108)

 

The high incarceration rate of African-American males is a direct result of sentencing practices, selective enforcement, and judicial biases.(109) Race plays a major role in how justice is administered in most state justice systems as well.(110)

 

The number of prison inmates that are incarcerated for drug related offenses overburdens state criminal justice systems across the country. In California, the prison population has more than tripled in the past twelve years due in large part to the incarceration of non-violent African American drug offenders.(111) Drug offenders make up a larger percentage of inmates today because their likelihood of conviction is much greater and their sentences are much longer.(112) Government spending on incarceration reflects this larger population of inmates.(113) Nonetheless, despite the increasing incarceration rate for drug offenders, there appears to be little or no effect on drug related crimes.(114)

 

Clearly, the significant risk factors for imprisonment are race, poverty, and involvement in the drug culture. Because African Americans accumulate at the bottom of the class structure in the United States, race, poverty, and drug use are predictors of incarceration.(115) The link between race, poverty, drug use, and imprisonment are inescapable.(116) Of significant concern is the fact that anal intercourse and intravenous drug use, two methods highly conducive to transmitting the HIV virus, are omnipresent throughout the America's prisons.(117)

 

Two deadly killers have now entered the prison setting, HIV and AIDS. The rate of HIV infection continues to rapidly increase among our country's incarcerated. Some prison systems report that approximately fifty percent of their inmates are HIV-positive. When AIDS and rape converge within our prisons, many inmates face an unintended form of capital punishment, a brutal attack by another prisoner and subsequent infection with a terminal and incurable disease.(118) Most alarming is that African Americans are disproportionately in prison; thus, creating a heightened risk for sexual partners within prison and in the community following release.(119)

 

In the twenty-first century, the opportunity exists to develop a more effective and dramatic approach to the spread of AIDS among African Americans. Now is the opportunity to act on facts, not preconceived notions or prejudices. With established organizations such as the American Medical Association, American Bar Association, and the Centers for Disease Control all defining drug addiction as a disease, lawmakers should work together to devise a strategy to end the criminal justice approach to drug use.

III. A PRACTICAL APPROACH TO ELIMINATION OF THE AIDS CRISIS IN THE AFRICAN AMERICAN COMMUNITY

While medical professionals and many others view drug addiction as a public health problem, it has been defined in the United States as a criminal justice problem. Former Drug Czar Edward Bennett, for example, at one point went so far as to suggest that beheading might be a "morally plausible" solution for drug dealers.(120) The decade of the 80's saw an increase in addiction to new and potentially more devastating drugs (notably crack/cocaine) and enhanced criminalization of drug abuse.(121) The increase in use of drugs occurred simultaneously with an obscene neglect of urban problems: homelessness; unemployment; collapse of urban education systems; and impoverishment.(122) Instead of a comprehensive social justice program, the country as a whole and most individual states emphasized draconian sentencing systems and increased use of imprisonment as the methodology to deal with these larger social/political issues, including drug addiction.(123)

 

The medicalization approach to drug addiction, by encompassing in the medical domain some phenomenon or problem, allows medical considerations to be decisive in the interpretation of the problem and in the choice of measures to resolve the situation.(124) With respect to drug use, medicalization can have a broad range of meanings and consequences. When it means providing normal, good quality medical care to drug addicts, including the prescription of illicit drugs, medicalization should be applauded as a positive development.(125)

 

One reason medicalization often is hailed as a more humane approach to drug policy than reliance upon the criminal justice system alone is because of the expectation that in the medical model, addiction no longer will be stigmatizing because it is considered a disease, and, hence, addicts no longer will be accused of being the cause of their problems.(126) Another reason is that it still seems impossible to promote serious discussion of the more radical approach of repealing drug prohibition and creating a set of legal regulations for the different groups of substances.(127) Therefore, some proponents of legal regulation hope that medicalization may be an instrument in the transition to a legalized system, while other 'legalizers' accept medicalization as the second-best alternative. As the debate between advocates of drug prohibition, legalization/regulation and medicalization rages forward, public policy, without question must immediately address intervention services, and treatment availability. As the war on drugs has been a utter failure, the primary focus of the drug policy must change. First, policy should be implemented that would provide for the development of education programs to prevent behavioral pathology linked to HIV/AIDS transmission. Second, resources should be made available to provide treatment programs for all first time and habitual drug offenders seeking recovery. Third, public health policy to deal with needs poor women, in particular African American women with AIDS. Lastly, there should be a restructuring of the drug policy from "criminalization to medicalization," therefore, de-emphasizing incarceration for drug use, and increasing public health efforts to combat the spread of AIDS among African Americans. These efforts should include treatment and rehabilitation for all addicts, and a national needle exchange program for those that cannot be rehabilitated.

A. Education programs

Intervention efforts must begin early to prevent individuals from using drugs and becoming involved in the inner city drug culture. Intervention and prevention programs must be designed with long-term goals in mind. Therefore, at-risk youth should be targeted to prevent them from becoming involved in the inner city drug culture. Drug awareness and education programs are a crucial element in this effort. Specific money should be allocated and used for prevention. Programs. It is very important that legislation is enacted that provides for block grant funds that can be used for drug awareness and prevention programs. Policies most definitely affect the kinds of programs or interventions that are available for at-risk youth. A program designed to prevent at-risk youth from becoming involved in the inner city drug culture should be comprehensive in scope, and designed using a strengths-based model that focuses on the individual and the family's most positive characteristics. The program should be intensive and include structured supervision, mandatory drug/alcohol education, ongoing assessment, group and individual counseling, family counseling, emotional support, recreational therapy, and a myriad of wraparound services designed to support healthy and responsible living.(128) In developing these strengths, the youngster and his or her family will be empowered to develop a drug-free lifestyle and accomplish goals for responsible living.(129) Indeed, an enlightened policy needs to expand the continuum of where and how services are provided not only for at-risk youth, but also for all individuals that are addicted to drugs.(130)

B. Drug Treatment for All Addicts

Anyone who wants to quit using drugs should be able to receive appropriate publicly funded treatment. Furthermore, addicted single parents need residential treatment that will not break up families. Pregnant addicts especially need treatment, not imprisonment. Today, however, most treatment programs will not accept pregnant addicts.(131) Similarly, HIV-positive addicts should be the top priority for treatment, yet currently many programs will not take HIV-positive people. All drug-addicted prisoners should get treatment, but no one should be prosecuted or imprisoned simply to get treatment.(132)

The Center for Substance Abuse Treatment reports that a collection of surveys, studies, and demographic analyses consistently points to a gap between the demand for substance abuse treatment and its availability.(133) For example, in 1996 the National Household Survey on Drug Abuse estimated that 5.3 million persons aged 12 and over and living in households were diagnosed as needing drug treatment, but only 37 percent of that number received it in the same year.(134) This "treatment gap" must close if addicts are to receive treatment, and thus reduce the spread of AIDS in the African American community.

If the laws and policies were changed in an effort to address the health care issues involved in drug addiction, and thus, shifted the priority away from incarceration to health care and thus, rehabilitation, there would be more programs and a greater ability to address the specific needs of the addict, to educate them, and to expand prevention services.(135) That would be a lot better than simply incarcerating people for taking drugs. A public health expansion of drug treatment would reduce crime, health hazards, recidivism, and the spread of HIV/AIDS.(136) There is no question that the expansion of drug treatment would be a tremendous help in our battle to eliminate the spread of HIV/AIDS in urban America. A shift in focus would also allow for mandatory long-term treatment that would educate injection drug users who were recently released from prison on parole about.(137) In addition, a health care approach to drug use prevention would assure that the special needs of female drug addicts to be met.

C. Addressing the Needs of African American Women with AIDS

The failure of the public health system to adequately address the particular difficulties experienced by African American women exasperates the problem of HIV/AIDS in African American community. This special subset of African American female drug users with HIV/AIDS will require special attention in prevention, treatment, and intervention programs in order to reduce their drug use.(138) This may mean incorporating more aggressive outreach strategies, providing appropriate ancillary services, studying the causes of drug abuse and physical differences in addiction, developing relapse-prevention plans and aftercare programs, and altering the therapeutic approach in several ways--for example, modifying counseling styles and gender ratios of treatment groups.(139) For women on the street, outreach and training efforts might target individuals with whom women have regular contact, such as employers, key family members, and clergy.(140) Intervention efforts might focus on women's needs, coping styles, and patterns of symptoms associated with substance abuse.(141) Moreover, for this special subset of women, social skills training and the reconfiguration of the social network are extremely important in the drug abuse rehabilitation of women.(142) Special attention should be directed toward emotional and spiritual well-being, family relationships, intimate relationships, social environment, and coping skills.(143) Thus, for these women, it is important to change their social setting through drug treatment and for them to terminate old relationships and develop new, more positive relationships. Once in treatment, however, relapse-prevention planning and aftercare services are needed to assist women in assertiveness training and social skills building and in acquiring needed job skills and education.(144)

 

Compounding the difficulties African American female drug addicts is the fact that there is a history of medical mistreatment and health care exploitation.(145) Thus, African American women that have been infected with HIV approach the health care system with anxiety, fear and distrust.(146) A practical approach to addressing needs of women of color and HIV/AIDS would require behaviors such as: reinstatement of community hospitals; assuring urban pre-natal and perinatal care; recognizing the needs of the community; training health care providers and institutions about the African American perspective, thus making the barrier of distrust easier to overcome; and aggressively reducing the existing disparities in health care delivery in the African American community.(147)

D. Mandating Needle Exchange Programs

In the United States, criminal justice authorities cast drug dependency as an evil or moral wrong to be penalized. Public health professionals regard drug dependency as a medical condition to be treated, managed, and, if possible, cured. These competing approaches have long spawned conflict between the criminal justice and public health systems, but never have the differences been more divisive than in the debate over syringe availability, that is, the prescription, sale, distribution, and exchange of drug injection equipment.(148)

The tenets of the criminal justice model hold that illicit drug use and its instrumentalities, including syringes, must be criminally proscribed.(149) Syringes, essential for delivering injection drugs, are seen as an integral and pernicious part of the illegal drug trade and of the underground drug subculture.(150) Syringes have become a metaphor for illicit drug use itself and associated criminal activity, family disintegration, child neglect, economic ruin, and social decay.(151) To many, legalizing, and particularly promoting, the possession and use of sterile drug injection equipment sends the wrong message, encourages initiation into drug use, and undermines moral and family values.(152) Historically, American drug policy has closely conformed to the criminal justice model; legislation, regulations, and professional practice guidelines at the federal, state, and local levels comprise a complex and pervasive web of laws that severely restrict access to sterile injection equipment.(153) Through this body of law, the United States has adopted a policy that consciously creates an artificial scarcity of syringes.(154)

The public health approach, not unlike the criminal justice approach, recognizes the disutilities of drug use and supports interventions that discourage drug use or that facilitate treatment of drug users.(155) Unlike the criminal justice construct, however, the public health framework advocates harm reduction, a strategy that seeks to minimize health risks for injection drug users.(156) Public health professionals reason that persons who persist in using drugs might nevertheless mitigate the considerable and demonstrable health risks of injection drug use.(157) Accordingly, harm reduction strategies embrace education, counseling, and the means for safer injection practices.(158) A key aspect of a harm reduction strategy for injection drug use is to maximize the lawful distribution and use of sterile injection equipment.(159) These harm reduction measures, which promote access to drug injection equipment, encompass three interrelated policies: permitting physicians to write prescriptions for syringes, authorizing pharmacists to sell syringes over-the- counter, and legalizing and funding syringe exchange programs.(160) From a public health perspective, physicians who prescribe syringes, pharmacists who dispense syringes, and intravenous drug users who possess syringes should not face criminal penalties for complying with public health recommendations.(161)

 

Critics of needle exchange programs charge that public policy should limit the harm addicts are doing to themselves and to others as a result of their addictions. In Baltimore, however, the city provided needles for addicts who either could not or would not stop using drugs.(162) Baltimore's needle exchange program began in August 1994 and became the largest local government-run needle exchange program in the nation. More than 1.4 million needles were exchanged through the program during its first four years and it served more than 6,000 addicts.(163) In launching the needle exchange program, the City of Baltimore gave addicts the opportunity to exchange used needles for clean ones in hopes of reducing the transmission of HIV among injection drug users. The results of this effort were good.(164) Johns Hopkins researchers, who evaluated the program, found that enrolled addicts lowered their risk of contracting AIDS by almost 35%.(165) Needle exchange has been valuable from a drug treatment standpoint. Some participants, who initially were drawn to the program because of the promise of free needles, later used the program as a stepping-stone to drug treatment.(166) The most recent results, also from Hopkins, show that the success rates of the Baltimore needle exchange clients in drug treatment are remarkable.(167) Also those in the program who continued to use drugs have benefited through their participation.(168) Studies show there is a 20% reduction in frequency of drug use among program participants.(169) Additionally, there has been a reduction in needle sharing and other drug behaviors that put addicts at high risk for contracting AIDS.(170) The bottom line is that needle exchange saves lives. This is the message that should be promoted and lawmakers should extend needle exchange programs nationwide. Lawmakers should awaken to the fresh thinking of Baltimore and change the national drug policy. There are no silver bullets or panacea solutions; however, the drug war under its current construction has done little or nothing to reduce crime, addiction, and AIDS.(171)

CONCLUSION

The spread of HIV/AIDS in urban America must be curtailed. First, social policy must establish and implement expansive education and prevention programs specifically designed to eliminate the behavioral pathologies that have placed the urban poor particularly at risk of HIV infection; next, the impact of HIV/AIDS on women of color and the potential consequence of overlooking this critical group must become the central focus social policy and health care reform; thirdly, a complete restructuring of the approach to drug use should be a preeminent concern of lawmakers because the criminalization of drug use is clearly ineffective as to the reduction of drug related crime, addiction, and HIV/AIDS. Lastly, all of the aforementioned suggestions as to legislative reforms and policy shifts should be immediately implemented in order to halt the spread HIV/AIDS in the African American community.

1. 1. Jefferson M. Fish, , RETHINKING OUR DRUG POLICY, 28 FDMULJ 9,48-51 Fordham Urban Law Journal, October, 2000 Conference. (noting remarks of the Mayor of Baltimore Kurt Schmoke. Mr. Smoke's presentation was during a section of the conference entitled Overviews of Drug Policy Effectiveness. Schmoke was the first mayor of a large city who called for an evaluation, and thus a re- evaluation, of drug policy). 2. 2. Id. 3. 3. Id. 4. 4. David Schultz, RETHINKING DRUG CRIMINALIZATION POLICIES, 25 Texas Tech Law Review 151, 165, 1993, 5. 5. David Simon and Edward Burns, THE CORNER: A YEAR IN THE LIFE OF AN INNER-CITY NEIGHBORHOOD, Chapter 2, pp. 60-64, 1997 (David Simon and Edward Burns (Simon & Burns) present a disturbing look at inner-city America through the eyes of McCulloughs, a family that has been decimated by drug addiction. The McCulloughs have been torn apart by crack cocaine and heroin addiction. Simon and Burns spent a year documenting life on the streets of Baltimore, Maryland. Their studies focused on the area near the corner of Fayette St. and Monroe St. Most significant in Simon and Burns reporting of the happenings on Fayette Street is the focus on the Government's response to the misfortune that had stuck West Baltimore. The response of the government was to form multi-level commando style task forces to arrest the primary players (young black men) and arrest them and incarcerate them for as long as possible. Simon and Burns highlight the fact that drug awareness education was minimal and treatment essentially nonexistent. The Government's answer, according to Simon and Burns, was to ensure further destruction of the community by further decimating families. Most enlightening in Simon and Burns study was that they recognized the healthcare element of drug addiction. Furthermore, they were firm in their belief that attacking the problem from a healthcare front, although not a perfect solution, is one likely to accomplish more than the criminal law approach.) 6. 6. Supra at note 1. 7. 7. Id. 8. 8. Id. 9. 9. Michael Tonry, TOWARDS A RATIONAL DRUG POLICY: RACE AND THE WAR ON DRUGS 1994 University of Chicago Legal Forum 25, 1994 10. 10 Id.   11. 11. Id.   12. 12.2 Id. 13. 13.3 Id. 14. 14.4 Id. 15. 15.5 Id. 16. 16.6 Supra at note 1. 17. 17.7 Steven B. Duke, DRUG PROHIBITION: AN UNNATURAL DISASTER, 27 Connecticut Law Review 571, 585 Winter, 1995 Commentary. 18. 18.8 Id.   19. 19.9 Supra at note 1.

20. 20.0 Id.

21.

21.1 Supra at note 5

22. 22.2 Id.

23.

23.3 Id. at 537 (explaining the inner city drug culture is multidimensional, and is not in anyway synonymous with African Americans or African American culture.)

24. 24.4 Id at 60.

 

25. 25.5 Id.

26. 26.6 Infra. at note 45, Pg. 1239

27. 27.7 Id.

28. 28.8 Carol Clark, PAYING THE PRICE OF AIDS: HUMAN, AND ECONOMIC TOLL REVERBERATES GLOBALLY available at http://www10.cnn.com/SPECIALS/2001/aids/stories/social.cost.html (Date last visited: Nov. 25, 2001) (quoting David Bloom, professor of economics and demography at Harvard University's School of Public Health)

29. 29.9 Id.

30.

30.0 HIV/AIDS Among African Americans, CDC: Divisions of HIV/AIDS Prevention, available at http://www.cdc.gov/hiv/pubs/facts/afam.htm (Date last visited: Nov. 25, 2001)

31. 31.1 Id.

32.

32.2 Id.

33.

33.3 Id.

34. 34.4 Id.

35. 35.5 Judith Porter Louis Bonilla Ernest Drucker, METHODS OF SMOKING CRACK AS A POTENTIAL RISK FACTOR FOR HIV INFECTION: CRACK SMOKERS PERCEPTIONS AND BEHAVIOR (Philadelphia, Pennsylvania), 6/22/97 Contemp. Drug Probs. (Pg #s. Unavail. Online), 1997 WL 12084582 (explaining crack addicts tend to engage in high-frequency sex with numerous sexual partners, especially in crack houses. In addition, there is growing speculation among researchers that regarding the potential for HIV transmission through the sharing of crack pipes or stems contaminated with blood from smokers' cut and burned lips, or from oral sex performed by crack users with injured lips).

36.

36.6 The National Institute of Allergy and Infectious Diseases of The National Institutes of Health. FACT SHEET: WOMEN AND HIV, April 1997. Available at http://www.niaid.nih.gov/factsheets/womenhiv.htm (Date last visited: Nov. 25, 2001) (noting in the United States, the majority of women are infected with HIV during sex with an HIV-infected man, while using HIV-contaminated syringes for the injection of drugs such as heroin, cocaine, and amphetamines, and behavior associated with the uses of crack. Of the new AIDS cases reported among women in the United States in December 1999, 40 percent were attributed to heterosexual contact and 27 percent to drug use.)

37.

37.7 Supra note 1.

38. 38.8 Lawrence O. Gosten, THE EPIDEMICS OF INJECTING DRUG USE AND BLOOD-BORNE DISEASE: A PUBLIC HEALTH PERSPECTIVE, 31 Val. U. L. Rev. 669, 670 Valparaiso University Law Review Spring, 1997 Drugs

39. 39.9 Centers for Disease Prevention Dangerous Intersection of Drug Use and Sexual HIV Transmission Points to Critical Need for Comprehensive HIV Prevention, Available at http://mywebmd.com/content/article/1680.50210 (Date last visited: Nov. 25, 2001)

40. 40.0 Id.

41. 41.1 Id.

42. 42.0 Id.

43. 43.2 Id.

44. 44.3 Id.

45. 45.4 Id.

46. 46.5 Id.

47. 47.6 Id.

48. 48.7 Id.

49. 49.8 Id.

50. 50.9 Id.

51. 51.0 Supra note 35.

52. 52.1 Eric Cohen, Gerald J. Stahler, CONTEMPORARY DRUG PROBLEMS LIFE HISTORIES OF CRACK-USING AFRICAN AMERICAN HOMELESS MEN: SALIENT THEMES, 6/22/98 Contemp. Drug Probs. (Pg. #'s not available online), 1998 WL 22139110. (Ethnographic research methods, which utilize the perspective of drug users to describe their life experiences and social realities).

53. 53.2 Supra at note 38.

54. 54.3 Susan L. Waysdorf, Families in the AIDS Crisis: Access, Equality, Empowerment, and the Role of Kinship Caregivers, 3 Texas Journal of Women and the Law, 145, 160 (1994).

55. 55.4 CDC Division of HIV/AIDS Prevention, HIV/AIDS AMONG U.S. WOMEN: MINORITY AND YOUNG WOMEN AT CONTINUING RISK,available at http://www.cdc.gov/hiv/pubs/facts/women.htm. (Date last visited: Nov. 25, 2001)

56. 56.5 Id.

57. 57.6 Richard Curtis, THE IMPROBABLE TRANSFORMATION OF INNER-CITY NEIGHBORHOODS: CRIME, VIOLENCE, DRUGS, AND YOUTH IN THE 1990S, 88 Journal of Criminal Law and Criminology 1233, 1260 Summer, 1998 Symposium: Why is Crime Decreasing?

58. 58. Supra at note 36.

59. 59.8 Id.

60. 60.9 Id.

 

61. 61.0 Susan L. Waysdorf, Fighting for Their Lives: Women, Poverty, and the Historical Role of United States Law in Shaping Access to Women's Health Care, 84 Kentucky Law Journal 745 (1995-1996).

62. 62.1 Id.

63. 63.2 Id.

64. 64.3 Supra at note 35

65. 65.4 Id.

66. 66.5 Id.

67. 67.6 H. Virginia McCoy; James A. Inciardi; Lisa R. Metsch; Anne E. Pottieger; Christine A. Saum, WOMEN, CRACK AND CRIME: GENDER COMPARISONS OF CRIMINAL ACTIVITY AMONG CRACK COCAINE USERS, (Pg #s unavailable) 9/22/95 Contemp. Drug Probs. 435451, 1995 WL 14945071

68. 68.7 Id.

69. 69.8 Id.

70. 70.9 Lisa M. Bianculli, THE WAR ON DRUGS: FACT, FICTION, AND CONTROVERSY, 21 SHLJ 169, 177, Seton Hall Legislative Journal 1997 Note (1997).

71. 71.0 Kate DeCou, U.S. SOCIAL POLICY ON PROSTITUTION: WHOSE WELFARE IS SERVED?, 24 New England Journal on Criminal and Civil Confinement 427, 429, Summer, 1998 Symposium: Women in Prison

72. 72.1 Id. at 445

73. 73.2 Juan R. Torruella, THE "WAR ON DRUGS": ONE JUDGE'S ATTEMPT AT A RATIONAL DISCUSSION, 14 Yale Journal on Regulation 235, 255, Winter 1997 Essay

74. 74.3 Supra at note 1 Pg. 76

75. 75.4 Supra at note 4. pp 161-162

76. 76.5 Id.

77. 77.6 Supra at note 1

78.

78.7 Id.

79. 79.8 William Spade, Jr., BEYOND THE 100:1 RATIO: TOWARDS A RATIONAL COCAINE SENTENCING POLICY , 38 Ariz. L. Rev. 1233, 1269-1272 Arizona Law Review Winter, 1996 (citing Judge Cahill, United States v. Clary, 846 F.Supp. 768, 787 (E.D.Mo. 1994), rev'd, 34 F.3d 709 (8h Cir. 1994), Cert. Denied, 115 S.Ct 1172 (1995) although Congress expressed a clear intent, in passing the 1986 Act, to target "kingpins" and "high level traffickers," national and local statistical data demonstrate that prosecutors and law enforcement officials are not targeting the upper echelons of the drug trade…[that] prosecutors and law enforcement officials were more focused on the race of particular crack offenders than the amount of crack they possessed).

80. 80.9 Christopher Mascharka, MADATORY MINIMUM SENTENCES: EXEMPLIFYING HE LAW OF UNITENDED CONSEQUENCES, 28 Florida State University Law Review 935, 240-242, Summer 2001 (citing Mistretta, 488 U.S. at 367)

81. 81.0 Id.

82. 82.1 Id

83. 83.2 Id.

84. 84.3 Id.

85. 85.4 Id.

86. 86.5 Id.

87. 87.6 Id.

88. 88.7 Pub. L. No. 99-570, 100 Stat. 3207 (1986) (codified as amended in scattered sections of 18, 21, & 31 of the U.S. Code).

89. 89.8 Id.

90. 90.9 Id.

91. 91.0 Id.

92. 92.1 Supra at note 79

93. 93.2 Id

94. 94.4 Pub. L. No. 100-690, § 6470(a), 102 Stat. 4377 (codified as amended at 21 U.S.C. §§ 846, 963 (1994).

95. 95. Supra at 78.

96. 96.6 Id.

97. 97.7 Id.

98. 98.8 Id.

 

99. 99.9 Id.

100. 100.00 Id.

101. 101.01 Id.

102. 102.02 Id.

103. 103.03 Id.

104. 104.04 Id.

105. 105.05 Floyd D. Weatherspoon, THE DEVASTATING IMPACT OF THE JUSTICE SYSTEM ON THE STATUS OF AFRICAN-AMERICAN MALES: AN OVERVIEW PERSPECTIVE, 23 Capital University Law Review 23, 35-37 1994

106. 106.06 Id.

107. 107.07 Id.

108. 108.08 Id.

109. 109.09 Id.

110. 110.10 Id.

111. 111.11 Supra at note 58

112. 112.12 Id.

113. 113.13 Id.

114. 114.14 Id.

115. 115.15 Scott Burris, PRISONS, LAW, AND PUBLIC HEALTH: THE CASE FOR A COORDINATED RESPONSE TO EPIDEMIC DISEASE BEHIND BARS, 47 University of Miami Law Review 291, 296, November, 1992

116. 116.16 Id. at 297

117. 117.17 Richard D. Vetstein, RAPE AND AIDS IN PRISON: ON A COLLISION COURSE TO A NEW DEATH PENALTY, 30 Suffolk U. L. Rev. 863, 864 Suffolk University Law Review Fall, 1997 Note.

118. 118.18 Id.

119.

119.19 Supra at note 1

120. 120.20 Marsha Weissman, THE CRIMINALLY-INVOLVED-DRUG ADDICT: PUBLIC POLICY AND SENTENCING ADVOCACY, Practising Law Institute PLI Order No. C4-4197 April 19-20, 1991 National Conference on Sentencing Advocacy 1991 159 PLI/Crim 179 pg 183]

121. 121.21 Id.

122. 122.22 Id.

123. 123.23 Id.

124. 124.24 Fredrick Polak , THINKING ABOUT DRUG LAW REFORM: SOME POLITICAL DYNAMICS OF MEDICALIZATION 28 Fordham Urb. L.J. 351, 352 Fordham Urban Law Journal October, 2000 Article

125. 125.25 Id.

126. 126.26 Id.

127. 127.27 Id.

128. 128.28 Arthur L. Burnett, Sr. , WHAT OF THE FUTURE? ENVISIONING AN EFFECTIVE JUVENILE COURT 15-SPG Crim. Just. 6, 7-10 Criminal Justice Spring, 2000.

129. 129.29 Id.

130. 130.30 Supra at note 1. Pg. 156

131. 131.31 Eric E. Sterling, THE SENTENCING BOOMERANG: DRUG PROHIBITION POLITICS AND REFORM 40 Vill. L. Rev. 383, 422-423 Villanova Law Review 1995 Symposium

132. 132.32 Id.

133. 133.33 Alvin W. Cohn, JUVENILE FOCUS, 64-JUN Fed. Probation 73, 74 Federal Probation June, 2000 Department

134. 134.34 Id.

135. 135.35 Supra at 1, Pg 156

136. 136.36 Id.

 

137. 137.37 Id.

138. 138.38 Supra at not 55.

139. 139.39 Id.

 

140. 140.40 Id.

 

141. 141.41 Id.

142. 142.42 Id

.

143. 143.33 Id.

144. 144.34 Id.

145. 145.35 Vernellia R. Randall, SLAVERY, SEGREGATION, AND RACISM: TRUSTING THE HEALTH CARE SYSTEM AIN'T ALWAYS EASY! AN AFRICAN AMERICAN PERSPECTIVE ON BIO-ETHICS, 15 Saint Louis University Public Law Review 191, 215, 234 (1996).

146. 146.36 Id.

147. 147.37 Id.

 

148. 148.38 Supra at note 26

149. 149.39 Id.

150. 150.40 Id.

151. 151.41 Id.

 

152. 152.42 Id.

153. 153.43 Id.

154. 154.4 Id.

155. 155.45 Id.

156. 156.46 Id.

157. 157.47 Id.

158. 158.48 Id.

159. 159.49 Id.

160. 160.50 Id.

161. 161.51 Id.

162. 162.52 Supra. at note 1, Pg. 50

163. 163.53 Id.

164. 164.54 Id.

165. 165.55 Id

.

166. 166.56 Id.

167. 167.57 Id.

168. 168.58 Id.

 

169. 169.59 Id.

170. 170.60 Id. at 51

171. 171.61 Id.

 

 
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Contact Information:
Professor Vernellia R. Randall
Institute on Race, Health Care and the Law
The University of Dayton School of Law
300 College Park 
Dayton, OH 45469-2772
Email: randall@udayton.edu

 

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