How to ensure every trans person has adequate access to trans-affirming care while incarcerated
On Aug. 16, 2016, Stacy Lorraine Naber, a transgender woman, was found dead in her cell in a mens prison facility at Dade Correctional Institution in south Florida. She had unsuccessfully attempted to change her legal name mere months before she was found dead. Florida law dictates that incarcerated people cannot legally change their names and that their legal names at the time of incarceration “shall be the inmate’s official identification throughout the continuous incarceration of the inmate… and must be included on any official document sent or received.” In addition to fighting for her legal name change, Naber also fought to receive comprehensive treatment for her gender dysphoria, but she was continuously denied.
Nearly 20% of transgender people are incarcerated at some point in their lifetime; for Black transgender women, the percentage is 47%. These high rates of incarceration are attributed to poverty, homelessness, discrimination, participation in street economics and law enforcement bias towards transgender individuals. While incarcerated, transgender people experience higher volumes of violence and isolation, specifically through the use of solitary confinement. Solitary confinement is used as a measure of “protection” for transgender people because of the higher rate of violence trans people face during their incarceration. However, for that reason, it is also a means for punishing gender expression. Additionally, transgender people who are incarcerated are often barred from access to health services and medication. Denying access to gender affirming medical care creates undesirable physical changes and is associated with depression, anxiety and suicidality. A 2013 study from the Social Science & Medicine journal examined health care providers’ attitudes toward and experiences providing care to transgender incarcerated individuals. The researchers found that adequate care for transgender individuals is not available during incarceration due to structural (e.g., lack of training and harmful policies) and individual factors (e.g., lack of cultural competence).
To combat this problem, the World Professional Association for Transgender Health (WPATH) created a standard of care, stating, “[h]ealth care for transsexual, transgender, and gender-non conforming people living in an institutional environment should mirror that which would be available to them if they were living in a non-institutional setting within the same community,” and “people who enter an institution on an appropriate regiment of hormone therapy should be continued on the same, or similar, therapies and monitored approach.” The standard of care WPATH recommends includes access to assessments, counseling, social transition, hormone therapy and surgical interventions for people experiencing gender dysphoria. The National Center for Transgender Equality has echoed the sentiments of WPATH by releasing policy guides to help expand access and care to incarcerated transgender individuals. These policy guides also state surgical intervention should be available for incarcerated transgender people, medications should not be interrupted and treatment decisions should be made by medical care providers, not administrators. Currently, some states allow detainees to continue hormone therapy but surgical intervention is universally denied.
Access to health care is a universal human right, and we have the responsibility to ensure that all incarcerated persons are receiving a standard of care that upholds this right. As demonstrated in the tragic case of Stacy Naber, denying trans affirming care in prison can be a death sentence.