World Day of Social Justice is on the 20th February 2024 and February also marks LGBT+ History Month in the UK. Therefore, in February, WEPHREN is focusing on LGBTQ+ issues in prisons. Below, Dani Plowman and Dr Chantal Edge from UKHSA outline work they commissioned in 2023 examining sexual health service provision in prisons for LGBTQ+ people. Dr Rachel Engelberg talks about the findings from her recent publication, ‘Challenges Unique to Transgender Persons in US Correctional Settings: a Scoping Review’.
UKHSA & the experiences of sexual health promotion amongst LGBTQ+ inclusion health groups
The limited evidence available suggests that LGBTQ+ people may be over-represented in people with experience of the criminal justice system. Stigma, both ‘felt and enacted’ stigma, is common amongst LGBTQ+ and those who are imprisoned or have been. Having dual identities has the potential to further marginalise these groups and may impact on health, wellbeing as well as access to services. Inequalities in sexual health are well established amongst some LGBTQ+ groups and imprisoned people. Ensuring sexual health promotion and support are inclusive is key to providing equitable care and reducing health inequalities.
During 2023 UKHSA commissioned exploratory research to investigate the experiences of LGBTQ+ inclusion health groups who are receiving or seeking out sexual health related promotion or advice and identify the barriers and facilitators in complying with the advice. The inclusion health groups approached were people with involvement in the criminal justice system, experience of homelessness, involvement in street or premises based sex-work, and/or with experience of substance misuse. The work was conducted by EP:IC, a consultancy with extensive experience of working in the criminal justice sector.
In total, 34 qualitative interviews were undertaken with participants in London and the Southeast of England, 11 of whom were people with experience of the criminal justice system. They found that access to sexual health support within prisons was a considerable challenge. For some participants, the main barrier to access related to fear that there would be consequences of seeking help, such as being moved off the unit. For other participants, the general lack of healthcare resource in prisons was the main barrier to sexual health support. A lack of LGBTQ+ awareness was a key barrier noted by participants, with participants afraid that disclosing a same sex relationship would lead them to be treated differently, with others noting experiences of misgendering. Issues around privacy during intimate examinations were also outlined as barriers to seeking care. Participants also noted the difficulty of accessing preventative items, such as condoms to ensure they could practice safer sex. However, there were some participants could see some of the solutions. Peers were viewed as a valuable way to access sexual health advice, with participants outlining that peer advisors were more likely to understand their needs and not judge them. One participant noted that more sexual health promotion within prisons would normalise the fact that sex happens in prisons. Other participants suggested promoting sexual health via prison laptops, posters or via Inside Times (the prison newspaper). More information might be important in enabling people to assess whether they needed a health appointment and ultimately improve sexual health.
The full report and journal publication will be available later in 2024.
Dani Plowman is a public health specialty registrar in the Kent, Surrey and Sussex in the UK. In 2023, she was on placement at UKHSA in the Health equity and inclusion health team.
Dr Chantal Edge is National Lead for Health and Justice, Health Equity and Inclusion Health Division, UK Health Security Agency
Transgender people in detention settings in the USA.
Transgender individuals are at increased risk for criminal legal involvement due to a variety of discriminatory and socioeconomic practices widespread within society. Given that prisons often conform to a binary interpretation of gender, our team sought out to determine what specific challenges transgender individuals may face while incarcerated. We found that, among incarcerated transgender persons, there is an increased risk of interpersonal violence, poor health outcomes, inconsistent access to gender-affirming care, harmful housing assignments, and a culture of transphobia. These findings better delineate critical areas in need of extensive reform. Alongside efforts to decarcerate and destigmatize, such knowledge can help provide better protections for vulnerable populations in within the carceral system.
To read the full paper, please go to ‘Challenges Unique to Transgender Persons in US Correctional Settings: a Scoping Review’
Dr Rachel Engelberg is an Assistant Professor in the Division of General Internal Medicine at the Icahn School of Medicine at Mount Sinai and a Clinician Educator at Mount Sinai Internal Medicine Associates. Prior to joining Mount Sinai, she participated in a T32 post-doctoral research fellowship through NYU Grossman School of Medicine, earning a Masters of Science in Clinical Investigation. She completed her internal medicine internship and residency training at Weill Cornell Medical Center in New York City, and obtained her M.D. from the University at Buffalo Jacobs School of Medicine and Biomedical Sciences.
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