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Int J Prison Health. 2018 Jun 11;14(2):69-88. doi: 10.1108/IJPH-02-2017-0011.

Creating, reinforcing, and resisting the gender binary: a qualitative study of transgender women's healthcare experiences in sex-segregated jails and prisons.

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Departments of Epidemiology and Behavioral and Social Sciences at the Brown University School of Public Health , Providence, Rhode Island, USA.
Fenway Institute, Fenway Health, Boston, Massachusetts, USA.
Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles , Los Angeles, California, USA.
Department of Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, Yale University , New Haven, Connecticut, USA.
Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University , New Haven, Connecticut, USA.
Department of Epidemiology, Fenway Institute, Fenway Health, Boston, Massachusetts, USA.
Division of Pediatrics, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University , New Haven, Connecticut, USA.


Purpose Incarcerated transgender women often require healthcare to meet their physical-, mental-, and gender transition-related health needs; however, their healthcare experiences in prisons and jails and interactions with correctional healthcare providers are understudied. The paper aims to discuss these issues. Design/methodology/approach In 2015, 20 transgender women who had been incarcerated in the USA within the past five years participated in semi-structured interviews about their healthcare experiences while incarcerated. Findings Participants described an institutional culture in which their feminine identity was not recognized and the ways in which institutional policies acted as a form of structural stigma that created and reinforced the gender binary and restricted access to healthcare. While some participants attributed healthcare barriers to providers' transgender bias, others attributed barriers to providers' limited knowledge or inexperience caring for transgender patients. Whether due to institutional (e.g. sex-segregated prisons, biased culture) or interpersonal factors (e.g. biased or inexperienced providers), insufficient access to physical-, mental-, and gender transition-related healthcare negatively impacted participants' health while incarcerated. Research limitations/implications Findings highlight the need for interventions that target multi-level barriers to care in order to improve incarcerated transgender women's access to quality, gender-affirmative healthcare. Originality/value This study provides first-hand accounts of how multi-level forces serve to reinforce the gender binary and negatively impact the health of incarcerated transgender women. Findings also describe incarcerated transgender women's acts of resistance against institutional and interpersonal efforts to maintain the gender binary and present participant-derived recommendations to improve access to gender affirmative healthcare for incarcerated transgender women.


Correctional health care; Health in prison; Mental health; Prison staff; Prisoners; Transgender women; Violence

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