Transgender Health Disparities in Prisons

Many healthcare disparities already exist for transgender people; they are more likely to be refused care on the basis of their gender identity, or their healthcare provider may be uncomfortable with (or uninformed about) transgender healthcare. Furthermore, mental health services, hormone therapy, and sex reassignment surgery are often not covered by health insurance, meaning that these services can be extremely expensive. These challenges, among others, also increase the likelihood that transgender people become homeless and have trouble obtaining housing¹.

The high rates of poverty and homelessness experienced by transgender people can lead to sex work and substance use, which puts them at risk for arrest. Additionally, they may face discrimination and abuse from law enforcement officers. Transgender people have a disproportionately high incarceration rate of 17% compared to the general United States incarceration rate of 0.4%^2,3. Within the prison system, transgender people face improper housing, violence and victimization, and lack of access to adequate healthcare⁴. These issues are perpetuated by a lack of understanding of common transgender health disparities and transition healthcare as well as a lack of set policies regarding the treatment of transgender individuals in prisons.

In correctional facilities, housing assignments are usually based on sex assigned at birth. In a survey of transgender women at a mid-sized Southern city men’s jail, participants described being assigned to a special housing unit that combines all inmates who are LGBT, suffer from mental illnesses, have disabilities, or are sex offenders. These participants reported harassment from other inmates and felt unsafe in this housing unit but said that the jail staff often ignored their complaints. Study participants had differing preferences as to what facilities they would prefer being housed in, but all expressed the sentiment that prisoners should be consulted when housing is assigned².

Moreover, transgender people are at a greater risk for violence in prisons; reports show that 47% of incarcerated transgender people experience victimization from inmates and staff, including verbal harassment, purposeful humiliation, physical assault, and sexual abuse^1,2. Given this violence, transgender prisoners may require more medical care than their cisgender peers; however, 25% of transgender inmates are denied access to healthcare during their imprisonment. Transgender individuals also require medical care related to hormone therapy, but only some states allow for the continuation of hormone treatments while in prison; gender reassignment surgery is nearly always denied. Furthermore, adequate general care and gender-affirming care are not provided².

A 2016 study of the NYC correctional system revealed that there was no adequate healthcare policy for transgender patients in prison. To correct this, LGBT sensitivity training was given to staff in all NYC jails, and transgender care policy was revised. The policy decreased barriers for patients to continue hormone therapy while in prison and allowed patients to begin hormone therapy while in jail. This revised policy addressed medicine dosage, treatment issues, side effects, follow-up evaluation, risks and benefits of therapy, and informed consent, and all NYC jails conducted staff training on the new policy. Three months after the LGBT sensitivity training, patient complaints dropped by over half; six months after the implementation of the new transgender care policy, complaints dropped to zero¹. The formation of inclusive policies like this can help to increase the quality and accessibility of both general healthcare and healthcare related to gender transition for transgender inmates.