Contemporary transgender health experience and health situation in prisons: A scoping review of extant published literature (2000–2019)

Abstract

Background: Many jurisdictions globally have no specific prison policy to guide prison management and prison staff in relation to the special needs of lesbian, gay, bisexual and transgender (LGBT) prisoners despite the United Nations for the Treatment of Prisoners Standard Minimum Rules and the updated 2017 Yogyakarta Principles on the Application of International Human Rights Law in relation to Sexual Orientation and Gender Identity. Within LGBT prison groups, transgender people represent a key special population with distinct needs and rights, with incarceration rates greater than that of the general population, and who experience unique vulnerabilities in prisons.

Aims/Method: A scoping review was conducted of extant information on the transgender prison situation, their unique health needs and outcomes in contemporary prison settings. Fifty-nine publications were charted and thematically analyzed.

Results: Five key themes emerged: Transgender definition and terminology used in prison publications; Prison housing and classification systems; Conduct of correctional staff toward incarcerated transgender people; Gender affirmation, health experiences and situational health risks of incarcerated transgender people; and Transgender access to gender-related healthcare in prison.

Conclusions: The review highlights the need for practical prison based measures in the form of increased advocacy, awareness raising, desensitization of high level prison management, prison staff and prison healthcare providers, and clinical and cultural competence institutional training on transgender patient care. The review underscores the need to uphold the existing international mandates to take measures to protect incarcerated transgender people from violence and stigmatization without restricting rights, and provide adequate gender sensitive and gender affirming healthcare, including hormone therapy and gender reassignment.     

HIV/AIDS in scottish prisons: Attitudes of staff and prisoners

Abstract

Prison is commonly regarded as a high risk environment for the transmission of HIV/AIDS. Five hundred and fifty-nine prisoners and 591 prison staff sampled from 8 Scottish prisons completed questionnaires concerning attitudes towards various issues of HIVIAIDS. A majority of prisoners and prison staff expressed liberal attitudes with respect to HIV/AIDS. For both staff and prisoners, the most liberal responses were to items dealing with personal and social contact with people with HIVIAIDS. A majority of prisoners and prison staff expressed conservative attitudes in relation to screening of individuals for HIV. With regard to differences between prisoners and prison staff, prisoners were more supportive than prison staff of the provision of free condoms to homosexuals and free condoms and syringes to intravenous drug users, and the provision of free medical care to both groups in the case of AIDS. Among the prisoner sample, intravenous drug users, in comparison to non-users, were found to be more positive in their attitudes toward HIVIAIDS on a wide range of issues. The implications of the study for health psychology are discussed with regard to prisoner and prison staff educational needs and prisoner management.     

Characteristics of incarcerated women's participation in groups: Exploring the Programme for the International Assessment of Adult Competencies United States prison dataset

This study employs logistic regression and latent class analyses to explore the relationship between incarcerated women's (n = 252) participation in nonacademic prison groups/skills classes and their demographic (e.g., education) and prison context (e.g., time to release) characteristics, using the 2014 Programme for the International Assessment of Adult Competencies United States prison dataset. Time to release was a significant factor in readiness class participation. Time to release and race/ethnicity were significant factors in addiction group participation. Education level had the largest effect size across all groups/classes explored. We discuss counseling implications for using group/class screening to connect with incarcerated women, especially those with intersecting and historically marginalized identities.     

Experiences of transgender prisoners and their knowledge,attitudes, and practices regarding sexual behaviors and HIV/STIs: A systematic review

Background: Despite transgender people being more visible in prison systems, research suggests they are at higher risk of experiencing sexual violence compared to other prisoners. Research also suggests that transgender prisoners experience harassment, and physical and sexual assault by fellow prisoners, and prison officers who lack transgender-specific health knowledge. There exist no systematic reviews on the experiences of transgender people in prisons. This review aims to fill this research gap. The following question developed in consultation with transgender, sexual health/HIV and corrective services stakeholders has guided the systematic review: What are transgender and gender-diverse prisoners’ experiences in various prison settings and what are their knowledge, attitudes and practices regarding sexual behaviors and HIV/STIs?

Methods: The review followed the PRISMA guidelines and searches were conducted in four databases for the period of January 2007 to August 2017. Studies were assessed against predetermined inclusion and exclusion criteria. Included studies were peer-reviewed, written in English with online full-text availability and reported data on transgender and gender-diverse prisoner experiences relevant to the research question.

Results: Eleven studies (nine qualitative, one quantitative, one mixed-methods; nine in USA, two in Australia) met the criteria for review. Four studies were of high quality, six were of good/acceptable quality, and one study was of modest quality. Transgender and gender-diverse prisoners reported a range of challenges which included sexual assault, discrimination, stigma, harassment, and mistreatment. Information on their sexual health and HIV/STIs knowledge, attitudes, practices is in short supply. Also, their lack of access to gender-affirming, sexual health/STIs and mental health services is commonplace.

Conclusions: The experiences of transgender prisoners as reported in this review are almost uniformly more difficult than other prisoners. Their “otherness” is used as a weapon against them by fellow prisoners through intimidation and violence (including sexual) and by prison officers through neglect and ignorance.     

Theology of Desire

Abstract

A white-hair asks, as a man, when I meet a woman, what do I sense? This is answered as a single young man, a married father, a divorced man, and as an elder. From a pre-Sixties youth where sex was religiously defined in terms of marriage and women as mothers-to-be, through the Free Sex movement as a young adult, to experiences of prison sex as a religious radical, into married, divorced and finally elder sexuality, the search is to understand the play of sexuality and intimacy. "Slap the bitch!" prison sex makes clear the source functionality of the mythic Adam's Rib account in determining the currently dominant global view of sexuality and intimacy in the digital age. A vision of coupled presence is presented wherein ritual practices are referenced that enable men and women to embody the fullness of their sexuality and intimacy.     

Pray erformance

Abstract

Female prisoners in recovery may anticipate defeat when projecting possibilities for their future hopes and dreams. These clients often identify with and attach to the role of prisoner and addict. This article describes a 12-week group treatment program, titled by the author as “Prayerformance.” In this work, female prisoners in recovery have an opportunity to connect spiritually and psychologically by using techniques like role play, improvisation, spontaneity training, storytelling, character development, mask work, and movement.     

A Stark Examination of Prison Culture and Prison Ministry

Abstract : This article offers an insightful examination of prison ministry from the inside, from someone who has been involved with this ministry for over forty‐five years. The author discusses four major issues that are particularly costly, both in terms of personal human costs and also financial costs. First, society's misconceptions about prison violence, and the complex, varied ways prisoners experience violence. Second, the false sense of security the current practices of institutionalization create, and the consequences they have on the inmates. Third, the risk factors that can predispose children to ending up in prison, and the lack of care and attention those children often receive. And fourth, the way in which the criminalization of drug abuse has exacerbated many problems with the current prison system. The author concludes his article with some suggestions for reforming the prison system.     

Prison Theology: A Theology of Liberation,Hope and Justice

Abstract : In our nation today, the number of prisons and prisoners continue to grow at rates that are out‐of‐control. One in 100 of our citizens is in jail or prison, the highest ratio in the world. Unlike the poor, homeless, critically ill, and elderly, those in prison are separated from us to the degree they are unseen. Unseen also, is the oppressiveness of the criminal justice system that oversees more than 6.5 million people either in confinement or on probation or parole. Liberation theology, which advocates and works toward freeing people from oppression, includes feminist, black, womanist and Latino/Hispanic movements. This article proposes prison theology as part of the liberation theology family and identifies a prison theology based on liberation, hope and justice. It encourages a prison theology movement led by the church to liberate those under the oppressiveness of the criminal justice system, especially those confined and to energize a passion for justice and compassion for the oppressed throughout the criminal justice system.     

The influence of perceived prison crowding on male inmates' perception of aggressive events

This study examines whether, in a male prison, the subjective experience of crowding increases the likelihood that events are perceived as aggressive in nature, and whether the protagonists involved are viewed as more hostile, malevolent, and aggressive. In addition, this paper also examines the possible mediating effects of stress, arousal, and psychological well‐being on two hypothesised relationships. First, these mediating factors are examined for the link between individuals' personal space preferences and their perceived level of crowding. Second, these factors are examined for the link between perceived crowding and interpretations of an aggressive event. Such associations may help to explain why crowding and aggression are linked within a social interactionist perspective. The results confirmed previous findings that crowding is linked to increases in arousal and stress, and a reduction in psychological well‐being. This study also found, however, that those inmates who experienced crowding were also more likely to interpret behaviour as aggressive and violent. This relationship was not mediated by arousal, stress, or psychological well‐being. However, these factors were found to partially operate in the relationship between personal space preferences and the experience of subjective crowding. The implications of this study for social interactionist explanations of the link between crowding and prison violence are offered. Aggr. Behav. 30:273–283, 2004. © 2004 Wiley‐Liss, Inc.     

Reconfiguring Older Bodies in the Prison Time Machine

It is by mapping an area that the geographer comes to understand the contours and formations of a place. The place in this case is the prison world. This article serves to map moments in prison demonstrating how old female bodies are performed under the prison gaze. In this article I will illustrate how older women subvert, negotiate, or invoke discourse as a means of reinscribing the normalizing discourses that serve to confine and define older women's experiences in prison. Female elders in prison become defined and confined by regimes of femininity and ageism. They have to endure symbolic and actual intrusions of physical privacy, which serve to remind them of what they were, where they are, and what they have become. This article will critically explore the complexity and contradictions of time use in prison and how they impact on embodied identities. By incorporating the voices of elders, I hope to draw out the contradictions and dilemmas which they experience, thereby illustrating the relationship between time, their involvement in doing time, and the performance of time in a total institution (see Goffman, 1961), and the relationship between temporality and existence. The stories of the women show how their identities are caught within the movement and motion of time and space, both in terms of the time of the real on the outside and within prison time. This is the in-between space of carceral time within which women live and which they negotiate. It is by being caught in this network of carceral time that they are constantly being remade as their body/performance of identities alters within it. While only a small percentage of the female prison population in the United Kingdom are in later life, one has to question why criminological and gerontological literature fail to address the needs of a growing significant minority.     

Learning By Going Inside

This story of the beginnings of a career in prison reform, is an example of the interplay between spirituality and mental health practices. Through anecdotes of actual experiences inside prison, Father Chinlund communicates a sense of life “inside” as it is for the most motivated prisoners. There were many in the prisons he visited who turned their incarceration into a good thing, transforming their prison cells into something like monastic cells.Stephen Chinlund, an Episcopal priest, was Chairman of the New York State Commission of Correction, responsible for advising the Governor on corrections policy, from 1976 to 1981. In 1981, he conceived and developed a prisoner-family program. From 1986 until recently he was Executive Director of Episcopal Social Services in New York City. Correspondence to Stephen Chinlund, 445 West 19th Street, New York, NY 10011, USA; e-mail: stephenchinlund@yahoo.com.     

Traumatic events and early maladaptive schemas (EMS): Prison guard psychological vulnerability

Introduction and objectiveGuards are employed to maintain prison security partly because of inmate violence. In this environment, traumatic events such as attacks are frequent. In the aftermath of such events, two major psychopathological consequences can affect guards: (a) post-traumatic stress symptoms (PTSS) or disorder (PTSD or ASD) and (b) early maladaptive schema (EMS) re-enactment. The current study addresses inmate-on-staff attacks in terms of post-traumatic stress symptoms (PTSS) and EMS re-enactment.Method and resultsTwo hundred and thirty-five prison guards were assessed for (1) PTSS with the Impact of Event Scale-Revised, and (2) EMS with SCP II, a French EMS inventory. Post-traumatic stress symptoms are high among prison guards and “mistrust” EMS are significantly more re-enacted than other EMS. Correctional guards with PTSD show significantly higher EMS re-enactment levels than those without post-traumatic stress symptoms.ConclusionsIt appeared that inmate-on-staff attacks cause re-enactment of “mistrust” EMS in particular. We hypothesize a particular relationship between EMS and PTSD: after a traumatic event, EMS may be re-enacted. Once EMS are re-enacted, they act as a risk factor for post-traumatic stress symptoms. In return, post-traumatic symptoms may maintain EMS enactment. Further studies are necessary; nevertheless, we now know the importance of psychological help for prison guards.     

When home is in jail: child development in Spanish penitentiary units

The quality of the educational family context of children who live with their mothers in prison (N=127, age M=16.3 months) as well as how this situation affects their level of development are analysed. The assessment of these contexts was carried out using the HOME scale. The evaluation of the children's development was carried out using the Brunet–Lézine scale. The data shows that the quality of this context is extremely low, with one of the most striking features being the low score obtained in the subscales of provision of play materials and variety of experiences. Moreover, there are significant differences in the scores that are related to the mother's level of education, ethnic origins and the type of prison where they are serving their sentences. As for the scores obtained by the children in the Brunet–Lézine scale, the data shows that their level of development is similar to that of the infant population in general although we also found that the development quotients of the children in the group with the lowest scores in the HOME scale tend to drop significantly after 18 months of age. The results are discussed taking into account the interaction of context and development under the light of the canalization hypothesis, and making some suggestions about possible ways to improve these children's life conditions. Copyright © 2003 John Wiley & Sons, Ltd.     

Évaluation des dimensions psychopathiques sur le mode d’adaptation carcérale

IntroductionThe disorders associated with the coping styles of detainees in prisons, including the interaction between individual and the environment, can be approached in two ways. Either as the result of a normal reaction of prisoners with regard to specific components in a pathogenic environment, or resulting from psychopathological determinants inherent to inmates prior to incarceration.ObjectivesThis study aims to measure the impact of components related to personality traits deemed stable and observed among inmates in regards to their modes of adaptations to the prison environment. More specifically, observing the types of adaptation of prisoners, according to their scores on the Hare psychopathy checklist (PCL-R).MethodsThe study is based on a series of interviews conducted on a sample of 26 inmates in three different detention centers located in France.ResultsThe results show a strong relationship between some psychopathic dimensions and characteristics of conduct disorder or disciplinary offenses in prison. High scores in both factor 1 (interpersonal and emotional relationship) and factor 2 (social deviance) strongly correlates with disciplinary problems such as heteroaggressive violence towards staff or other inmates. While a high score of factor 2 only increases the risk of disciplinary problems, such as group violence or involvement in trafficking.ConclusionsThe presence or absence of certain personality traits that characterize psychopathy could determine how an inmate would adapt to the prison environment.     

Countering Correctional Discourse

SUMMARY

This article discusses the development of a feminist support group for women prisoners enrolled in a six-month substance abuse treatment program in an adult correctional facility in Guam. After the completion of five Group cycles, a follow-up study was conducted in the community using qualitative, feminist, and participatory methods. Results indicate that the Group was successful in helping women prisoners to address trauma, addiction, and the stresses associated with incarceration. Nevertheless, participants reported having significant difficulty transitioning into the community upon release and 23% were sent back to prison for parole violations. Recommendations are outlined for gender-responsive programming, both within women's prisons and in the community, to support women offenders after release.     

Psychological support needs of patients with head and neck cancer and their caregivers: A qualitative study

Objective: The aim of this study was to explore the psychological support needs of patients with head and neck cancer (HNC) and their caregivers. The appropriate timing, length, format and content of sessions were also investigated.

Design: Eighty-three patients with HNC and 73 of their caregivers completed questionnaires at diagnosis. Follow-up questionnaires were mailed to patients six months later.

Main outcome measures: Free text-comments to open-ended questions in the questionnaires were analysed using an inductive thematic approach with coding and theme development directed by the content of responses. This was used to determine psychological support needs both at diagnosis and at six month follow-up.

Results: Patients described ‘just being there’, empathy, maintaining normality and practical support as helpful from family/friends. They desired information, honesty, positivity and empathy from clinical staff. Formal psychological support was desired by approximately 40% of patients and caregivers, particularly early after diagnosis and during treatment. Most participants desired face to face sessions, providing individualised information and coping strategies.

Conclusion: The results of this study suggest that psychological interventions for patients with HNC and their caregivers should be delivered early after diagnosis in face to face sessions, presenting honest and factual information about the disease and coping strategies.     

Womanist Therapy with African American Women with Disabilities

Abstract

African American women are at increased risk for disabilities. There is very little information available, however, regarding psychological interventions with African American women with disabilities. The purpose of this article is to discuss psychological intervention in working with African American women with acquired disabilities from a womanist perspective. Themes and interventions will be discussed. Recommendations for working with African American women with disabilities in a therapeutic context will be offered.     

Weapons used in prison assault: A profile of four Florida prisons

The purpose of this study was to investigate the incidents of inmate aggression that resulted in violence within four Florida Correctional Institutions. The prisons differ structurally and in classification of inmates — two are medium and two are close custody (high) security prisons. The study investigated the type of weapon used in relation to the propensity for and frequency of noncollective (inmate-to-inmate or inmate-to-staff) violent incidents at the two types of prisons. The result indicated that the scope and nature of assault varied greatly from prison to prison mostly as a result of freedom of movement to make weapons and the security classification of the inmates housed.     

La pratique physique,un moyen de circonscrire les effets délétères du confinement en milieu carcéral : impact d’un programme d’activités physiques sur la santé perçue et le bien-être psychologique de détenus

To be in prison consists in enduring the enticements of multiple stressors and constraints leading to an unpredictable and often uncontrollable situation. This generates serious health troubles and distress in the population living in prison. Physical Exercise (PE) is well acquainted for its benefits in terms of health and as such it seems reasonable to suggest its contribution in ameliorating life conditions among detainees, although the literature on the subject is quite scanty. The present report shows that moderate PE may contribute actively in ameliorating the health status. Notably perceived stress and other psychological factors are significantly improved in a small and particular population of detainees, sex offenders.