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Although there are currently no systematic efforts to document the number of transgender and gender diverse (TGD) people in U.S. jails and prisons, research finds that TGD people are disproportionately incarcerated in the United States relative to the general population.1 Some evidence suggests that 16% of the estimated 1.4 million transgender adults in the United States2 have been incarcerated in their lifetime,3 compared with just 3% of the general U.S. population.4 Although both trans feminine people and trans masculine people are at disproportionate risk for incarceration, the incarceration rate is particularly elevated among trans feminine people, with lifetime estimates of incarceration ranging from 19% to 65% across studies.3,5–7

One of the main drivers behind the high burden of incarceration among TGD people is stigma. Stigma is the social process of labeling, stereotyping, and rejecting human difference as a form of social control.8,9 Stigma restricts access to resources for TGD people, including employment and housing, leading some TGD people to turn to street economies, such as survival sex work or substance use to cope with mistreatment, which places them at higher risk for arrest and incarceration.3,6,10,11 Biased policing and sentencing practices also contribute to high rates of incarceration among TGD people.3,12

Once incarcerated, TGD people are typically housed in sex-segregated facilities according to their genitalia. Thus, TGD people who have not had genital construction surgery are typically placed in facilities that do not match their gender identity or expression; for example, trans feminine people are typically incarcerated in men’s prisons. Once incarcerated, TGD people are at high risk for experiencing verbal, physical, and sexual assault.3,13,14 Victimization of TGD people may be perpetrated by other inmates as well as jail and prison staff.3,13,15 These risks are particularly elevated for trans feminine people in men’s facilities, where femininity is not only devalued but routinely punished.16–18 Notably, experiencing victimization in correctional facilities has been shown to contribute to poor physical and mental health for TGD people.14,19–22

Like all detainees, incarcerated TGD people may need to access physical and mental health services to meet their preventative, chronic, and urgent health care needs; some TGD people may also require medical care to affirm their gender. Medically affirming one’s gender can include the use of exogenous hormone therapy (e.g., estrogen for trans feminine people, testosterone for trans masculine people) or surgery (e.g., genital construction surgery) to feminize or masculinize the body. Hormone therapy may be the first or only form of medical gender affirmation intervention sought.23 Given that TGD people may require a variety of health services while incarcerated, access to supportive health care professionals who are knowledgeable about TGD people and their needs is essential to ensuring the health of incarcerated TGD people.

This chapter uses the ecological (or ecosocial) model of transgender stigma20 to outline ...

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