Transgender health behind bars: How to improve care

In a Monday session on transgender health and health disparities, two presenters took a look at how to improve care for an even more marginalized group: transgender prisoners.

Kirsty Clark and Jackie White Hughto, two Yale University researchers, presented their findings during an Annual Meeting presentation on “Development and Pilot Testing of a Transgender Knowledge Intervention for Correctional Health Care Providers.”

Clark and White Hughto told attendees that although transgender people make up approximately 0.6 percent of people in the U.S., 16 percent of transgender people, as well as 21 percent of transgender women, will be incarcerated in their lifetimes. This disproportionate number can be attributed to lifetime stigma against transgender people, who face discrimination in housing, education, health care and employment, so many are forced into “underground economies,” such as sex work and selling drugs, in order to survive. Because these activities are criminalized, transgender people end up facing a higher risk of arrest and imprisonment.

Once incarcerated, Clark and White Hughto noted that transgender people may be placed in dangerous situations — including being housed in prisons that do not match their gender identity, as many prisons do not allow transgender prisoners unless they have had “bottom” surgery. They may also face discriminatory attitudes from health care providers within the prison system.

To address the problem, Clark and White Hughto developed a Transgender 101 training for prison health care providers that educates on definitions and terminology; understanding transgender people in corrections, as well as the biases and social factors that led to incarceration; and gender-affirming interactions and gender-affirming health care.

After working with correctional health care providers in New England, including prescribers, nurses, psychiatrists, psychologists, social workers and counselors on both day and night shifts, the providers reported back to researchers that they felt more knowledge about transgender health issues and were more comfortable talking to transgender prisoners in ways that affirm their gender identities.

Clark and White Hughto said their next steps include developing a more comprehensive survey, expanding the intervention to include more case studies, offering a basic primer on hormones and gender-affirming surgeries, describing the role of mental health and medical prescribers in hormone access and monitoring, explaining how to offer gender-affirming cancer screening and teaching the essentials of trauma-informed care. They hope to offer such trainings through a web-based portal to any correctional staff who would like to use them.