https://orcid.org/0000-0002-1307-1794
Hostile socio-politico-medico climates within and beyond the prison walls
Trans people across many parts of the world are subsumed and inculcated by cisnormative and regulatory logics. In recent years, the rights and visibility of trans individuals have come under increased and disproportionate scrutiny. The hostile socio-politico-medico climate surrounding trans rights manifests in various ways, from discriminatory laws and policies to trans rights being ‘weaponized’ by right-wing populists and widespread societal prejudice. Since 2021, in the United States (US) hundreds of state laws and policies have been introduced targeting trans people’s healthcare access, legal recognition, and visibility in public spaces (ACLU, Citation2024). For example, Florida Senate Bill HB1557—“Don’t Say Gay or Trans” - that curtails the discussion of LGBTQ+ topics in schools (Florida State Legislature, Citation2022); Arizona State Bill SB1700 that prohibits books that “promote gender fluidity or gender pronouns” (Arizona State Legislature, Citation2023); and Kansas Senate Bill 180—that disallows any legal position for a person with a gender identity not matching the gender assigned at birth (Kansas State Legislature, Citation2023). Such anti-trans legislation and sentiments are equally prevalent in other parts of the world, with countries in Asia, the Middle East, and Africa persecuting and criminalizing trans communities (Chiam et al., Citation2019; Noralla, Citation2022). In turn, there has been a sharp rise in anti-trans tropes, publications, and protests across many parts of the world including Australia, the United Kingdom (UK), within Latin American countries (Carbajal, Citation2022). Trans hate crimes in the UK increased by 11% in 2023 (Home Office, Citation2023) with the UK Home Office (Citation2023) reporting that comments by politicians and within the media may have led to an increase in these offenses.
Incarceration settings are a site of heightened oppressive logics, politics, and social forces and highlight how the prison industrial complex contributes to the structural and systemic discrimination and everyday violence trans people face. Scholars have proposed that interlocking forces of oppression can inform, maintain, and exacerbate pathways to incarceration, contributing to the over-representation of trans people in custodial populations (Clark et al., Citation2023). Indeed, internationally, trans people are disproportionately incarcerated with studies reporting 16%–19% lifetime incarceration compared to 2.5% of the general United States (US) population, for example (Clark et al., Citation2023; Maruschak & Minton, Citation2020; United Nations Office on Drungs and Crime, Citation2020). Once incarcerated, many trans people suffer from daily discrimination, psychological distress, physical and sexual violence, risk of sexually transmissible infections, including HIV, and typically face acute intersectional disadvantage given the over-representation of racialized, poor, and aging people in incarcerated populations (Clark et al., Citation2023; United Nations Office on Drungs and Crime, Citation2020). Sexual assault is 13 times more prevalent among trans people in US prisons, with 59% reporting sexual assault compared to 4.4% of a randomly selected control group (Jenness et al., Citation2007). Many trans women in men’s prisons are housed in administrative segregation and face prolonged isolation for reasons of purported ‘safety’ (Brömdal et al., Citation2019). UK and US studies have also demonstrated that trans populations face multi-level barriers to gender-affirming and psychological care in prison, including absent or restrictive policies, discriminatory staff attitudes, and a lack of cultural and clinical competency (Brömdal et al., Citation2019; Sevelius & Jenness, Citation2017; Van Hout et al., Citation2020).
Trans health and social disparities before incarceration are well documented and have been associated with experiences of pervasive stigma, violence, and discrimination in gaining employment and housing (Garofalo et al., Citation2006; Hughto et al., Citation2022; Van Hout et al., Citation2020). Thus, many enter incarceration settings with mental health, substance use, infectious diseases, and other medical conditions, resulting in complex care needs (Hughto et al., Citation2022; Van Hout et al., Citation2020). The increasing aforementioned legislative efforts targeting trans people worldwide, not only exacerbate existing health disparities but are also hypothesized to contribute to the oppression-to-incarceration cycle (Clark et al., Citation2023). This cycle suggests that trans individuals’ exposure to anti-trans stigma, prejudice, and discrimination drives their disproportionate interaction with the criminal-legal systems. This, in turn, exposes trans people to the harms of the prison system and then limited reentry resources upon release, perpetuating a cycle of oppression-to-incarceration (Clark et al., Citation2023)
Because many trans individuals already face mental and physical health disparities prior to entering carceral settings, trans people in prison settings likely have poorer health than their cisgender peers (Hughto et al., Citation2022). In turn, correctional and prison health systems have struggled to address trans people’s needs and human rights effectively due to a lack of research to understand this population, integrated approaches to their care and safety, and interventions to promote incarceration alternatives. However, in recent years more attention and collaborative efforts toward trans incarceration research have emerged. To showcase some of this emergent work, the International Journal of Transgender Health has produced a collection of trans incarceration research. The papers featured examine chronic health conditions between trans and cisgender individuals with recent incarceration in the US (Will et al., Citation2023), correctional policies for the management of trans people in Australia (Winter, Citation2023), a global review of correctional staff knowledge, attitudes and behaviors toward incarcerated trans people (Daken et al., Citation2023), complexity of housing preferences of incarcerated trans women in Australian and the US (Brömdal et al., Citation2023), and the challenges faced by trans individuals when they navigate the realms of justice and legal systems in Pakistan (Alamgir, Citation2024).
These studies crucially focus on investigating and addressing the extreme and immediate harms that result from legal system and incarceration practices. This collection not only showcases the diverse research approaches currently undertaken toward these immediate harms and needs, but also allows us to reflect on the current state of research in this area, barriers and opportunities for advancing research, and some innovative research approaches despite the barriers, in order to advance a transformative trans carceral research agenda. Together, by addressing the immediate harms and attending to the larger project of acknowledging and rectifying the systemic and structural factors that oppress, discriminate, and punish trans people, we envisage a transformative trans carceral research framework to both support those currently incarcerated with the long-term vision to dismantle the pathways to incarceration.
The state of trans incarceration research: barriers and opportunities for advancing research
Trans incarceration research has tended to be located in the Global North, with an overwhelming focus on studies based in the US. Despite this, there has more recently been increasing diversification and deepening of trans carceral research, as exemplified by the first international edited collection in this area (Maycock et al., Citation2024). A common thread across current trans incarceration research relates to the significant challenge of doing this research. This is primarily due to a combination of hostile socio-politico-medico climates that are impacting on research institutions, compounded by a lack of access to reliable data including currently and formerly incarcerated trans people creating substantive challenges for research in this area.
Limited access to high-quality data on currently and formerly incarcerated trans people
Within carceral settings, access to accurate and comprehensive data is severely limited in general terms, and is particularly compromised in relation to trans people, thereby complicating efforts to understand and address the needs of incarcerated trans people. One of the primary challenges is the lack of standardized data collection on gender. This is in part influenced by trans individuals for many reasons not wanting to disclose their gender, including engaging in detransitioning, within carceral systems that are often institutionally transphobic to avoid facing victimization and violence (Brömdal et al., Citation2023). A second challenge is the limited access to currently incarcerated trans individuals for research purposes, including participant surveys, interviews/focus groups, and studies developing and accessing interventions to support incarcerated trans people. Our team and others have documented difficulties in obtaining multiple approvals by research ethics committees, including approval and cooperation from carceral administrators, who serve as primary gatekeepers to researchers, particularly during times of heightened public scrutiny (Brömdal et al., Citation2019; Brömdal et al., Citation2019; Simpson et al., Citation2017).
Due to the challenges associated with accessing reliable data, much of the existing literature relies on theoretical accounts and retrospective reports obtained through qualitative interviews (White Hughto et al., Citation2018) or surveys (Hughto et al., Citation2022) with formerly incarcerated trans individuals. While these retrospective research approaches have been crucial in informing our understanding of trans health in carceral settings, they are vulnerable to recall bias and may not fully capture the nuances of trans experiences within these environments. Moreover, the predominant reliance on retrospective data hinders the ability to provide real-time or longitudinal assessments of health outcomes before, during, and after incarceration. These are notable research gaps. Limited data from currently incarcerated trans people also impedes efforts to implement timely and responsive interventions, whether therapeutic resources or policy changes, within and beyond carceral settings and erodes efforts and mechanisms to hold criminal-legal systems accountable for their duty of care (Clark et al., Citation2023).
Innovative research despite data challenges
Despite these challenges, innovative research approaches have emerged across disciplines. For instance, researchers have used unconventional sources such as letters written by incarcerated trans individuals to shed light on psychological aspects of resilience and self-advocacy within an Australian prison systems (Du Plessis et al., Citation2023; Halliwell et al., Citation2022, Citation2023). Some researchers have obtained and reviewed data from at times hard to access carceral policy documents regarding incarcerated trans individuals (e.g. Brown & McDuffie, Citation2009), with one recent study highlighting the wide variation in policy coverage across all Australian and New Zealand jurisdictions, underscoring, in concordance with human rights standards, the need for reforms (Dalzell et al., Citation2024). Suggested reforms included access to gender-affirming healthcare, treatment and housing options while serving their time, and further consideration of alternative sentencing options, including collaborative policy development with trans, gender diverse and non-binary people (Dalzell et al., Citation2024). Exploring the population-level impacts of incarceration on trans individuals, quantitative social scientists have recently sought to utilize data from the limited publicly available health surveys that include information on diverse gender identities as well as carceral status (Harvey et al., Citation2022). In one notable study utilizing data from the statewide Minnesota Student Survey, the sole youth-focused health survey in the US administered in both public schools and juvenile correctional facilities, researchers demonstrated that trans and sexual minority youth within carceral settings experienced markedly worse mental health and more traumatic experiences compared to both their non-incarcerated peers in public schools and their incarcerated cisgender-heterosexual counterparts (Clark et al., Citation2022).
Future directions for trans incarceration research
Much of the research conducted in the trans carceral space, including those using innovative approaches apply, what Baldry et al. (Citation2014) term, a “liberal reformism” approach which works to improve the conditions for incarcerated trans people through reforms while improving “the system’s functionality”, its policies and implementation (p. 171); which can inadvertently and ultimately lessen the possibility of long-term visions of decarceration. However, Baldry and colleagues, draw a distinction between “liberal reformism” and “[r]adical expressions of reform”, where the latter is “driven by reduction and decarceration aspirations” (2014, p. 171). Importantly, it looks at possible alternative methods of accountability for those who do harms (Lamble, Citation2015) outside the criminal-legal systems as well as “organizing against the interlocking structural and systemic forms of injustice, discrimination, inequality and oppression” (Baldry et al., Citation2014, p. 183). As such, radical expressions of reform driven by decarceration logics form what they refer to as a “transformative framework”, which seeks social [justice] rather than criminal justice” (Baldry et al., Citation2014, p. 183). Importantly, they identify that a transformative framework “is about looking beyond the prison… [to provide] a vision for a new way of thinking about, living within, and seeing the world”, where a radical reformist agenda and an abolitionist agenda work hand in hand toward the ultimate goal of decarceration and alternative solutions to imprisonment (Baldry et al., Citation2014, p. 171; Lamble, Citation2015).
Within the trans carceral space a transformative research framework opens up opportunities to closely explore some of the causes, mechanisms, and motives underlying some of the disproportionate incarceration figures of trans people, particularly trans femme/women (Clark et al., Citation2023; Hughto et al., Citation2022; Oparah, Citation2015; Reisner et al., Citation2014; Spade, Citation2015; Stanley et al., Citation2012; Walker, Citation2020), in an effort to weaken and dismantle the regulatory power of the trans criminal-legal system nexus (Jenness & Rowland, Citation2024; Lamble, Citation2015; Spade, Citation2015; Stanley & Smith, Citation2015; Stanley et al., Citation2012). But it also seeks to identify and address the harms trans people experience serving their time through strong reforms while being cognizant that such reforms do not compromise the long-term vision of decarceration (Baldry et al., Citation2014).
In this sense, and respectful of Stanley’s comment to acknowledge the historical organizing work that created and creates space for trans and queer critiques of incarceration (Daley & Radford, Citation2018; Stanley & Smith, Citation2015), our use of the term transformative trans carceral research framework, similar to Baldry et al, draws from ideas from abolitionist grassroots and scholarly projects that have been led in the US and Australia by queer, trans, First Nations, Black, disability and women’s support and advocacy groups (Baldry et al., Citation2014; Lewis, Citation2022; Stanley & Smith, Citation2015). Building on this knowledge, our framework employs Baldry et al.’s use of radical reform that pushes research toward transformative goals, including decarceration projects. To exemplify this transformative trans carceral research framework, we will address the articles part of this collection traversing the broad spectrum from liberal reformist to more transformative approaches. In doing so we will highlight the much-needed liberal reform-based research addressing immediate harms (see Alamgir, Citation2024; Will et al., Citation2023; Winter, Citation2023), and more radical reform-based work which aspires toward decarceration (see Brömdal et al., Citation2023; Daken et al., Citation2023)
In a creative response to the hard to access nature of data about trans communities, Will et al. (Citation2023) demonstrate a fluid methodological approach to trans carceral health. By using the electronic health record data from a US-based county health system, Will et al. (Citation2023) were able to open new avenues of exploration into the impact of incarceration on trans people, who exist within the doubly burdened intersection concerning health disparities, of being both trans and having been incarcerated. Overall, the liberal reform-based strategy used in this study seeks to provide better, more culturally competent interventions for trans people with regard to managing health conditions while incarcerated.
Alamgir’s (Citation2024) study of the Khawaja Sara and Hijra communities in Pakistan highlights the structural disenfranchisement these communities face despite the laws that are meant to protect them. Alamgir explores legal protections for the Khawaja Sara and Hijra communities not just at the carceral level but through the trans criminal-legal system nexus, culminating in a call for official accountability driven by the voices of the trans women who have, as the title states, struggled to find justice. It is a stark example of how legislation and policy can fail to reach the outcomes they are designed for and an example of bringing to light the voices of those formerly locked out of discussions about the protection of their own dignity, human rights and rights to gender affirming healthcare. The important contributions of this liberal reform-based study aim to inform policy and advocacy efforts leading to more just and equitable criminal-legal systems for trans people in Pakistan.
Winter’s (Citation2023) critical policy review similarly works to highlight where policy falls short, applying a benchmark of human rights standards to extant carceral policies managing trans people in Australian correctional centers. Included within this review are policies from South Australia and the Northern Territory—jurisdictions without publicly accessible trans carceral policies. Innovative approaches to data collection involve novel ways to do research and obtain previously unobtainable datasets. Here, Winter’s inclusion of previously difficult-to-access policies increases the transparency of correctional policies across Australia. This critical policy review highlights, within a liberal reform-based approach, the need for carceral policy reform across all Australian jurisdictions to: (1) meet the unique needs of trans people serving time, especially in the areas of administrative segregation and healthcare access; and (2) bring consistency across all Australian jurisdictions regarding the treatment of incarcerated trans people, to reduce disparate outcomes across states and territories.
Daken et al. (Citation2023) present a compelling case for transformative knowledge by using a predominantly liberally reform-informed corpus to challenge the placement of correctional staff and policies at the center of trans carceral ‘problems’, and solutions. The authors highlight how adhering to dominant discourses perpetuates violence against incarcerated trans people, and where liberal reformist approaches have failed to fill critical gaps in policy and outcome. They also present how a strong reformist agenda with a vision for social change and social justice, can work toward addressing the pervasive, structural and systemic harms trans people face within and outside of prison walls.
Finally, Brömdal et al. (Citation2023) employ notions of chrononormativity, heteronormative time, and queer temporality to explore the carceral housing preferences of trans women in Australia and the US, adding a nuanced, agentive lens to an ongoing and predominantly cisnormative debate, including how these housing preferences challenge governing and liberal reformist carceral housing systems. Here, a queer temporality framework exemplifies opportunities for a transformative trans carceral research approach. Here society and carceral systems are offered the opportunity to reflect on and address some of the mechanisms underlying some of the disproportionate trans incarceration figures, including make possible alternate methods of accountability for those who do harm.
Collectively, these five papers demonstrate a broad spectrum from liberal reformist to more transformative approaches, including some innovative methodological approaches to data and data collection. This potential is not just to carceral spaces but also to the fluidity of data, the idiosyncrasy of place, and the agentic and dynamic nature of trans people who drive this field and research surrounding it.
To conclude, the state of research concerning incarcerated trans peoples is marked by significant challenges, including a hostile socio-politico-medico climate, limited access to data, and a dearth of research outside of the Global North. Addressing these challenges requires concerted radical expressions and efforts of reform toward social change and social justice (Baldry et al., Citation2014) with the vision to address and dismantle pervasive systematic discrimination and violence faced by trans people within and beyond the prison walls. This includes harms such as being excluded from employment, housing, education, health and family, in an effort to reduce the very need to engage in activities deemed illegal to survive (Stanley & Smith, Citation2015; Stanley et al., Citation2012). Similarly, addressing these challenges from a transformative trans carceral research perspective, requires improved data quality and access, prioritized transformative and population-affirming research approaches, and the development of further research capacity within, and research leadership by, the trans community particularly those with lived experience of criminal-legal systems. This equally involves creating innovative research collaborations across disciplines and methodological strengths, including across global contexts where trans carceral research is not dominated by scholars from the Global North. Similarly, transformative trans carceral research needs to tap into multi-sector partnerships where trans carceral rights and health scholars partner with industry stakeholders such as policymakers, correctional staff and allied health personnel working in carceral settings.
With so many challenges and challenging gaps remaining in the socio-politico-medico trans (carceral) space, now more than ever a transformative trans carceral research framework is needed. As such, this Editorial stands as a call for an interlocking radical expression of trans carceral reform with the ultimate vision of decarceration (Baldry et al., Citation2014; Lamble, Citation2015; Oparah, Citation2015; Stanley & Smith, Citation2015; Stanley et al., Citation2012). Drawing on and inspired by prison abolitionists that have advocated in this space before us, this transformative framework is an opportunity to also question, wonder, and imagine what a transformative approach to trans incarceration research might look like, specifically regarding socially just solutions and implementation. More specifically, should a greater concerted effort be made to interview policy makers, judges, schools, workplaces, health settings to ascertain their attitudes to trans people with the aim of social justice? And what effect and affect may this have toward decarceration of trans people nationally and globally? Similarly, how does knowing attitudes change anything if there is no further action, and to that end, what is needed next? How should trans incarceration transformation be measured? Is a reduction in numbers of incarcerated trans people the measure, especially when capturing trans carceral data across the globe is far from present, consistent or transparent (Sanders et al., Citation2023)? And, would a reduction in numbers reflect on attitudinal socio-politico-medico change?
To end, a transformative approach to trans carceral research must capture nuanced and dynamic datasets of trans needs in the present and into the future. It must increase the quality and rigor of already existing datasets; capture voices silenced by gatekeepers, including the gatekeepers informing the status-quo; and find creative ways to access datasets which still evade trans rights and health scholars and grassroots advocates advocating for decarceration. Building on the work of prior trans/queer prison abolitionists (Lamble, Citation2015; Oparah, Citation2015; Stanley & Smith, Citation2015; Stanley et al., Citation2012) we call for transformative approaches to trans carceral research to begin by asking the following four questions in consultation with trans-communities: (1) “Does your work seek to make the PIC [prison industrial complex] a less workable solution to problems, and to limit its reach over [trans] lives?”; (2) “Does your work take on aspects of the PIC that are most harmful [to trans people]?”; (3) “Does your work suggests workable ways to maintain self-determination, meaningful safety, and collective health [for trans people]?”; and (4) “Does your immediate work make future challenges to the PIC possible?” (Critical Resistance, Citation2015, p. 388).
School of Education, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Australia
[email protected]
Charlie WinterSchool of Business, Law Flinders University Adelaide, Bedford Park, AustraliaTait SandersSchool of Communication and Arts, University of Queensland, Brisbane, AustraliaPaul Leslie SimpsonSchool of Population Health Faculty of Medicine, Health University of New South Wales, Sydney, AustraliaMatthew MaycockCriminology, School of Social Sciences, Monash University, Victoria, AustraliaKirsty A. Clark
Department of Medicine, Society Vanderbilt University Nashville, Health, Tennessee, USA
Acknowledgements
The authors would like to acknowledge the many abolitionist grassroots and scholarly projects that have been led in the US and Australia by queer, trans, First Nations, Black, disability and women’s support and advocacy groups.
Disclosure statement
The authors report no conflict of interest. The authors alone are responsible for the content and writing of this paper.
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References
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