Since 1970, the number of individuals held in criminal justice institutions for offenses related to illegal drugs has increased significantly. This can be attributed to the implementation of tough laws on illegal drug possession, use or distribution. The so-called “war on drugs” has done little to curb usage of drugs; instead, it has led to the development of other serious problems. One of these problems is the increased rate of HIV infection among inmates. Drug usage and sexual activities have provided a suitable setting for the spread of HIV. The condition is made worse by the fact that preventive mechanisms are not readily available to inmates as they are to members of the general public. This research proposal aims to study the effect the war on drugs has on the rate of HIV among inmates. It will be concluded that HIV infection rates in correctional facilities are high and will be proposed what can or should be done to curb this problem.
The war on drugs, launched in the 1970 by President Richard Nixon, has led to a significant increase in the number of individuals sent to prison. There is documented evidence that, whilst in prison, these individuals engage in practices such as substance abuse and same-sex sexual activities. Both of these activities lead to an increase in the rate of HIV among incarcerated individuals. This is because of the practices such as sharing syringes when using drugs and not using condoms during sexual activities.
The increase in the rate of HIV transmission in the criminal justice system is of vital concern to law enforcers and HIV awareness campaigners. HIV prevalence among prisoners is also a bother to members of the community into which they are released. This research proposal aims to study the relationship between the war on drugs and the rate of HIV among incarcerated individuals. Results from the proposed research (How has the War on Drugs affected the HIV rate of individuals in the criminal justice system?) can then be used to come up with appropriate methods of countering the spread of HIV in criminal justice systems.
This study is of particular interest to criminologist and criminal justice practitioners because of many reasons. Research has shown that practices inmates engage in make correctional facilities a hotbed for the spread of HIV. First of all, an intravenous drug use increases the risk of transmission of the virus because of the likelihood of prisoners sharing syringes. Another factor that facilitates the spread of the virus is unprotected sex among the prisoners. Condoms are contraband in most prisons, leaving limited options for protected sex. Since inmates are voluntarily tested when being admitted into prison, those infected before serving jail terms may introduce the virus to other inmates.
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Considerable information on how the war on drugs has led to increased rates of HIV infection among prisoners has been gathered and documented. Since the launch of the war on drugs, the number of individuals incarcerated for drug related offenses has significantly increased. Gupta (2011) states that in 2011, the total number of people in U.S. prisons was 2.3 million, and 25 percent of them were imprisoned because of drug-related offenses. The War on Drugs relates to a set of laws meant to discourage the production, distribution, and consumption of illegal drugs.
Gupta (2011) argues that the war on drugs has led to the arrest and imprisonment of millions of people involved in low-level offenses. This has led to infringement of civil rights and a heavy burden on taxpayers (about $70 billion is spent on prison and correction facilities). He continues to provide the statistic that there are about 2.3 million people in U.S. prisons, a figure that is three times more than the number of the imprisoned in 1987. Gray (2001) concurs with Gupta by arguing that the war on drugs has failed to meet its objectives. Instead, it has led to increased crime since drugs are now more accessible than before. He also argues that most of those arrested are small-scale users, while the drug lords go unpunished.
Gupta (2011) offers the opinion that a better way to deal with public health problems such as drug addiction is to provide treatment, which he says has proved more effective than imprisonment. Miron (2004) also argues that preventive measures such as counseling are far more effective than imprisonment. The argument is that most drug users go back to using drugs upon their release from criminal justice systems. For instance, a number of reforms that favor treatment over incarceration, implemented in Texas have led to a significant drop in crime rates (Texas Department of Criminal Justice, 2009).
Alain (2012) estimates that the U.S. has about 25 percent of the world’s total number of prisoners, a figure which starkly contrasts with its 5 percent share of the total world population. Alain states that:
We incarcerate more people per capita than any nation on the planet - about 2.5 million - and have another five million under parole or other form of supervision in their communities. This massive incarceration has been brought to us by the "war on drugs." Launched in the early 1970s by President Nixon, the campaign to stamp out drug use through arrest and imprisonment led to a stratospheric increase in the number of people, especially people of color, sent to prisons and jails. Further swelling available correctional facilities were the Sentencing Reform Act of 1984, curtailing alternative sentencing, the "three strikes" laws of the 1990s, and harsher sentencing guidelines for crack cocaine than for powdered coke (p. 1).
Apart from this, in a working paper prepared for the first meeting of the Global Commission on Drug Policies, Stevenson (2011) states that incarceration of low-level drug offenders is the main cause for the large number of incarcerated drug offenders (making up 40 percent of drug arrests). Simple possession of marijuana is one of the offenses that can lead to incarceration of the low-level offenders. Stevenson argues that instead of helping curb the menace of illegal drug use and distribution, incarceration of the low-level drug users leads to recidivism and additional criminal behavior.
The high number of incarcerated individuals is directly proportional to the rate of HIV infections. Several studies by various scholars and medical researchers indicate that the rate of infection among incarcerated individuals is relatively high when compared to other members of society. There is documented evidence of there being a direct relationship with being incarcerated and HIV. Alain (2012) describes that this connection is being established by the fact that the spread of HIV is particularly high among injection drug users and heterosexuals. These individuals are most susceptible to being at fault with the criminal justice system.
Mayer et al. (2010) provide statistical evidence to show that individuals under the control of the criminal justice system are at a higher risk of contracting than other members of the public. In their review of the book titled Human Immunodeficiency Virus in Correctional Facilities, the authors state, that, “the rate of reported AIDS cases among incarcerated persons is 5 times the rate of the general population in the United States” (2002, p. 1). The authors continue to point out that 35,000 jail and prison inmates were infected with HIV in any given day.
The authors of the article propose that, “the large numbers of drug users in the criminal justice system and their high risk of getting and transmitting HIV, STDs, and hepatitis” provide an opportunity and imperative need for drug addiction treatment services. These may include: education on prevention methods and ways of minimizing risk of infection, medical care for infected individuals, and collaborative efforts between prisons and the community in providing healthcare services for prisoners during and after their stay in prison (Mayer et al., 2010, p.1).
The authors continue to state that the criminal justice system provides many inmates with an opportunity to get basic health care, drug addiction treatment, and education or counseling on how to avoid being ensnared in the substance abuse menace. They argue that this would aid in breaking addiction cycles, help them avoid incarceration, and lead to their smooth transition into acceptable family and community. This will not only benefit the individual victims but the community at large, in the sense that it will lower transmission rates and health care and/or correctional costs.
In her article, “Failed War on Drugs Feeding HIV/AIDS, Former Leaders say”, Harris (2012) states that the war on drugs has failed to meet its intended objective, eliminating the distribution and use of illegal drugs. She reports that, on the contrary, the war on drugs has led to cheaper prices of illegal drugs and increased criminal activities by drug users. Because of their effort to avoid arrest by law enforcers, most drug users do not access medical care such as screening for diseases, condoms or even getting new sterile syringes from clinics. This has consequently increased the rate at which drug users, especially those in criminal justice systems, get HIV or distribute it to others.
In the article, Harris (2012) asserts that the report from the Global Commission on Drug Policy condemns the arrest and imprisonment of drug users who do not engage in criminal activities that harm other people. The commission, which includes six former presidents and sir Richard Branson, advocates for adoption of methods that have been proven to lower the rate of HIV infection among users. The article cites countries such as Switzerland and Portugal, where drug addiction is treated as a health issue and not a criminal act, are good examples of how HIV can be eliminated among drug users in prison if the right approach is taken. Among other recommendations, the commission urges that instead of arresting low-level drug users, law enforcement agencies should go for drug dealers and producers. It also recommends that preventive medical care should be availed to those with drug dependencies.
The high rate of HIV infection in correctional facilities is attributed to past and ongoing behaviors that predispose the jail and prison inmates to infection. According to Mayer et al. (2010), some of these behaviors include: sharing of syringes and other injection equipment, having unprotected sex, tattooing, body-piercing, and having multiple sexual partners.
Injection drug users and heterosexuals can be helped to protect themselves from HIV by being given access to syringes and condoms, but this is only possible outside prison. Despite there being knowledge that using condoms when having sex and not sharing syringes lowers the risk of contracting HIV, their access in prison is exceedingly limited. Malinowska-Sempruch and Gallagher (2004) state that prison officials have not embraced distribution of condoms and clean syringes in prison. This can be attributed to ignorance, or maybe, they just choose not to take into account the seriousness of the issue. Whilst those in the medical community may view drug users as individuals with chronic brain disorder, those in the criminal justice system view them as individuals who should be separated and punished for their criminal activities.
In their book, “War on Drugs, HIV/AIDS and Human Rights”, Malinowska-Sempruch and Gallagher (2004) point out that most male prisoners contract Aids through drug use practices such as sharing syringes, whilst women mostly contract the disease through engagement in unsafe sexual practices such as unprotected sexual contact. The authors argue that the unbalanced ratio of men to women in a community leaves women with little power when it comes to the choice of a partner. They continue to say that this gives men an undue advantage over women. Some men exploit this advantage, for instance by refusing to wear protection before sexual intercourse. This predisposes both groups to HIV infection.
Given that the rates of HIV infection and spreading are relatively high in criminal justice systems, they provide the best settings for testing, counseling, treatment, and prevention. In their article titled, “HIV Treatment in the Criminal Justice System: Critical Knowledge and Intervention Gaps”, Meyer et al. (2011) also agree with the sentiment that correctional facilities are a high risk setting for HIV infection, and therefore, a need to have HIV management programs is more than justified in these settings. Meyer et al. support their proposition by saying that management of HIV in some facilities has shown that it is highly feasible and acceptable. For instance, they state that, in Connecticut, 59 percent of infected inmates were able to achieve an undetectable viral load by the end of their terms.
Meyer et al. attribute the success of the HIV management program to the fact that equal access to health care enables impoverished individuals to access quality medical care that they would otherwise have not afforded outside prison. However, a significant challenge is that once these individuals complete their jail terms, most go back to their communities where they no longer have quality medical care.
In a meeting convened by the National Institute on Drug Abuse (NIDA) and the International Aids Society (IAS) in January 2010, it was agreed that the war on drugs has indeed increased the rate at which prisoners are infected HIV. Although many groups view the criminal justice system as a high-risk environment for HIV infections, consultants in the meeting postulated that it also provides an opportunity for treatment. The meeting’s report, “Prevention and Treatment of HIV/AIDS among Drug Using Populations” (2010), states that:
The high numbers of drug users involved in criminal justice systems presents both challenges and opportunities. The challenges are reflected in policies that prevent implementation of appropriate drug abuse treatment and HIV/AIDS services for prisoners that would improve their health and safeguard the health of their communities upon their release. The missed opportunities are for effective diagnosis, treatment, linkage to care, and prevention within the criminal justice system, and discharge planning and linkage to care in the community. This section will explore the high rates of incarceration among drug abusers and how this has led to unintended adverse consequences for their health and the health of their communities. It will then describe promising approaches for utilizing the criminal justice system as a means of delivering public health intervention (p. 1).
The report also raises concern over the dangers associated with contact between prisoners who have just been released and other members of society. Prisoners who may have acquired HIV whilst in prison may infect their sexual partners once they engage in sexual activities without protection. In another way, inmates who were on a highly active antiretroviral therapy (HAART) may not be able to access such medical care once out of the criminal justice system.
A major concern of many stakeholders is that, upon readmission into community, many victims relapse to earlier behaviors that jeopardize their health. Meyer et al. (2011) concur with this concern. In their article, they state that, “benefits of prison-based HAART are rarely sustained upon return to communities” (201, p. 1). For instance, they state that in the Texas criminal justice system, “few prisoners filled prescriptions for their HIV medications or enrolled in an HIV clinic within 30 days following release”. After being released, the victims find it difficult to adhere to HIV care services because of various responsibilities and temptations to continue using drugs. This negatively impacts their health and makes them a risk to the general community.
This research proposal is aimed at finding out if the war on drugs does contribute to the HIV infection rates amongst individuals in criminal justice systems. The research will look to establish ways in which HIV is transmitted amongst inmates and what can be done to stem them. Another objective is to find out whether attitudes and behaviors of inmates and law enforcers do contribute to the rate of infection among inmates. Last but not least, the research will also try to find out if the rate of HIV among individuals in the criminal justice affects other members of society and, if so, in what ways.
The war on drugs has led to an increase in the number of inmates convicted for drug related offenses. The large number of people in criminal justice systems poses a health risk to them, a condition which is further aggravated by the fact that HIV testing is voluntary in most of these systems. Given that HIV/AIDS is mainly spread through unprotected sex and sharing of injection paraphernalia, the probability of infections occurring in the prison context is unusually high. This is because sharing of sterile tools for injection, body piercing and tattooing is extremely common. This leads to the surmise that if sharing such instruments provides a means through which infection can occur, then the rates of HIV infection among individuals in the criminal justice system is high.
Method of Data Collection
The condition in criminal justice systems has not changed much in the last year. This, therefore, means that information obtained from researches conducted in the past year is still relevant. For this reason, this research will use secondary data sources. The main advantage of using data from secondary sources is that a clearer picture of the effect the war on drugs has on the rate of HIV infection in criminal justice systems will be formed. This will be made possible by the fact that several empirical researches will be compared to get the most consistent information. Another advantage is that time that would have been spent on conducting field research will be channeled to the analysis of empirical data from various researches relevant to this proposal’s interests. The only disadvantage is that it may be difficult to obtain information that conforms exactly to the needs of this research. However, this hurdle will be overcome by using many secondary sources.
Because of the increase in the number of individuals incarcerated for drug offenses, the likelihood of sharing injection and body piercing paraphernalia increases, therefore increasing the possibility of increasing rates of HIV infection among inmates. In this surmise, the dependent variable is the rate of HIV infection among inmates since studies have shown that it is dependent on their numbers. On the other hand, the independent variable is the war on drugs since it is not dependent on any factor in this research.
To analyze the rate of HIV infection amongst individuals in the criminal justice system (dependent variable), factors that encourage the transmission of HIV from one person to another will be studied. The research will also describe the relationship between the number of inmates and the rate of HIV infection. These factors will be selected on the basis of their relevance to the relationship between the war on drugs and the increase in the HIV infection rate among prisoners.
To explain how the war on drugs (independent variable) influences the rate of HIV infection among inmates, factors such as how it has led to the increase in the number of persons in the criminal justice system will be examined. This is relevant since it will provide the basis of some of the recommendations that will be given at the end of the research.
To measure the relevance of factors which encourage the transmission of HIV amongst individuals in the criminal justice system, it shall be determined to what extent they encourage transmission by asking and answering the questions. In their absence, would the rate of infection decrease? If individuals in the criminal justice system are provided with preventive measures such as sterile syringes and condoms, will be the rate of infection affected? If the number of inmates was decreased, would be the factors still relevant?
Validity of the measurement of the aforementioned factors will be established by seeking an expert opinion regarding their relevance to the research. For instance, factors that encourage the transmission of HIV from one individual to the other will be evaluated in different contexts to gauge their relevance. To determine whether the factors are reliable to this study, they will be measured in different contexts to establish their consistency, and those that prove inconsistent will be eliminated.
Sample and Sampling Technique
Data to be used in this research includes: the number of individuals incarcerated since the onset of the war on drugs, HIV infection rates before and after the war on drugs, the type of medical care availed to inmates, availability or access to sterile injection tools (or other tools through which HIV can be transmitted) and condoms. The data will be analyzed on a group basis since sources to be used in the proposed research do not provide much information at the individual level.
Individuals in the criminal justice system for drug related offenses are the target population for the proposed research. The secondary sources for the proposed research include the National Prisoner Health Information Committee ((NPHIC), Bureau of Justice Statistics (BJS), and the International Center for Prison Studies (ICPS). All of the information to be used in the research from the above sources was obtained by probability sampling (simple random sampling). This implies that cases of bias on data collected are minimal. The fact that more than two sources are used further minimizes unreliability that could be caused by bias (Kumar, 1999).
The information to be used was collected on both male and female prisoners incarcerated in various U.S. prisons. These individuals met the criteria of having been arrested for drug related offenses. Special emphasis is to be laid on those individuals who acquired HIV whilst in the criminal justice systems. This is because they will most likely provide information on the kinds of practices that predisposed them to HIV infection.
The proposed research will mainly involve quantitative analysis. This is because the goal of the research is to determine the relationship between the war on drugs and the rate of infection among inmates. The war on drugs has had a direct impact on the number of individuals in the criminal justice system since its inception. As a result, it is believed that this has had an effect on the rate of HIV infections in these institutions. This explains the rationale behind the proposed research’s goal of investigating how the war on drugs has impacted the HIV infection rates among inmates.
The war on drugs has provided a fertile setting for increased rates of HIV infection among individuals incarcerated in criminal justice systems. This is because the drug users continue using drugs in prison. Unlike outside prison where they are able to get sterile syringes, they have to share the limited ones in prison. This increases the likelihood of the spread of HIV among the drug users. These drug users may engage in sexual activities amongst themselves or with other prisoners. Given that condoms that would aid in prevention of the spread of HIV are limited (and sometimes not available at all) in prison, the risk of HIV infections is increased.
Several researchers have documented evidence to show that the increased number of incarcerated individuals as a result of the war on drugs has led to increased rates of HIV infection among them. However, few of them provide recommendations on what can be done to remedy the situation. This, therefore, implies that there is a need for future researchers to come up with suggestions on how to deal with the drug menace without necessarily arresting drug offenders. There is also a need to come up with programs that can help prisoners get preventive medical care and counseling so that they do not pose threats to other members of the community once out of prison. Failure to come up with corrective measures means that information collected so far by researchers will be of little relevance.
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