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Health care among LGBT Prisoners by country
According to Masen Davis, Executive Director of the Transgender Law Center, LGBT people in prisons often face barriers in seeking basic and necessary medical treatment, exacerbated by the fact that prison health care staff are often not aware of or trained on how to address those needs.[2]

United States

In May 2006, two transgender prisoners filed suit in January 2008 challenging a Wisconsin law that bars inmates from receiving hormones or sex reassignment surgery notwithstanding Principle 9 of The Yogyakarta Principles.[9] The significance of the Yogyakarta Principles is also stressed by "Handbook on prisoners with special needs"[31] published by the United Nations Office on Drugs and Crime.

Canada

On August 31, 2001, the Canadian Human Rights Tribunal concluded that Sections 30 and 31 of the Correctional Service of Canada contained discrimination on the basis of sex and disability in Canadian Human Rights Act.[32] After Synthia Kavanagh, a transwoman sentenced for life in 1989 for 2nd-degree murder, was sent to an institution for males. This institution assignment occurred despite the trial judge's recommendation that Synthia, as a transwoman, serve her sentence in a facility for women. Further, Synthia was denied sex reassignment surgery and hormones. The institutional policy, at the time, only facilitated cases which addressed conditions in which, reasonably, the plaintiff would seek sexual reassignment after the period of incarceration. Due to Synthia Kavanagh's life sentence, this was not a foreseeable option. "The decision to discontinue hormones in 1990 seems to have been based on the complainant's life sentence which made her, according to Dr. R. Dickey, apparently ineligible for ultimate reassignment. ... the diagnosis of transsexualism has been clearly established in this case" by expert witness testimony, throughout her trial, "She [had] responded well to feminizing effects of cross-gender hormones and has experienced no significant side effects. As established by legal precedent and confirmed by policy in Canadian and British Columbia Corrections Service, the complainant was entitled to continue her hormone treatment".[5]

In Petitioning the Canadian Human Rights Tribunal, Kavanagh argued that "The Correctional Service of Canada has discriminated and continues to discriminate against me because of my disability and sex (Transsexualism), contrary to Section 5 of the Canadian Human Right Act, by refusing to provide me with necessary medical and surgical treatment." Kavanagh continues to elaborate on her transition prior to imprisonment in this address, stating "since 1981 I have been diagnosed as a transsexual, which means that my gender is female but my sex is male. For 13 years, I was on estrogen hormonal treatment and lived as a woman, in preparation for my sex reassignment surgery to correct my medical disorder. In May 1990, my hormonal treatment was discontinued." After incarceration in a men's facility Kavanagh "repeatedly asked the CSC to arrange for evaluation for sex reassignment surgery, for the surgery to be performed and my consequent transfer to a women's institution." The discontinuation of hormone treatment and rejection of proposed sex reassignment surgery, paired with the continuation of periods of solitude prompted Kavanagh to respond "I believe that the CSC Policy discriminates against transsexuals, as the policy does not recognize the need for the continuation of medical treatment at the onset of incarceration, nor does the policy acknowledge the psychological need to be imprisoned with other members of one's psychological sex at the time of incarceration."[33]

Individuals with relatively short prison sentences with the requirement of completing the life trial within society does not seem unreasonable. Prison is not generally an appropriate setting for transsexual individuals to make decisions which are irreversible. The implications of refusing access to surgical reassignment for individuals with a life sentence or prolonged incarceration are however clearly more serious. For example, the Canadian Correctional Service in the Pacific Region alone had six transsexual inmates as of September 1994 with sentences of nine years or over and three with life imprisonment.[5]

The consequences of discontinued sex-reassignment procedure are especially evident in the cases of those subject to substantial prison sentencing. The Canadian Correctional Service in the Pacific Region alone had six transsexual inmates as of September 1994 with sentences of nine years or over and three with life imprisonment.[32]

LGBT youth prisoners In The United States
According to some studies, LGBT youth are particularly at risk for arrest and detention.[34] Jody Marksamer, Shannan Wilber, and Katayoon Majd, writing on behalf of the Equity Project, a collaboration between Legal Services for Children, the National Center for Lesbian Rights, and the National Juvenile Defender Center, say that LGBT youth are overrepresented in the populations of youth who are at risk of arrest and of those who are confined in juvenile justice facilities in the United States.[34]

A brief by the Center for American Progress found that each year approximately 300,000 gay, trans, and gender nonconforming youth are arrested or detained each year, 60% of whom are Black or Hispanic. These queer youth make up 13–15 percent of the juvenile incarceration system, compared to their overall population of 5–7 percent. Similar to how transgender adults are often placed into solitary confinement, allegedly for their own protection, these youth are "protected" in the same way. Often, however, it is because they are seen as sexual predators rather than potential victims. Courts also commonly assign queer youth to sex offender treatment programs even when convicted of a non-sexual crime.[35]

Physical and sexual abuse
According to Amnesty International, globally, LGBT prisoners and those perceived to be LGBT, are at risk of torture, ill-treatment and violence from other inmates as well as prison officials.[3] Amnesty International cites numerous cases internationally where LGBT inmates are known to have been abused or murdered by prison officials or fellow inmates.

Statistics show that 59% of transgender women in male prisons had been sexually assaulted while incarcerated compared to the 4% of the male-identified population. Transgender women in male prisons also deal with the risk of forced prostitution by both prison staff and other prisoners. Forced prostitution can occur when a correction officer brings a transgender woman to the cell of a male inmate and locks them in so that the male inmate can rape her. The male inmate will then pay the correction officer in some way and sometimes the correction officer will give the woman a portion of the payment.[36]

"[P]prisoners fitting any part of the following description are more likely to be targeted: young, small in size, physically weak, gay, first offender, possessing "feminine" characteristics such as long hair or a high voice; being unassertive, unaggressive, shy, intellectual, not street-smart, or "passive"; or having been convicted of a sexual offense against a minor. Prisoners with any one of these characteristics typically face an increased risk of sexual abuse, while prisoners with several overlapping characteristics are much more likely than other prisoners to be targeted for abuse."[4][37]

Physical and Sexual Abuse within The United States
Gay and bisexual men are often assumed to be responsible for the preponderance of sexual assaults perpetrated in prisons as has been reflected in various American judicial decisions. For example, in Cole v. Flick[nb 2] the court upheld the right of prisons to limit the length of inmates' hair, claiming that allowing them to wear long hair could lead to an increase in attacks by "predatory homosexuals".[38] In Roland v. Johnson,[nb 3] the court described "gangs of homosexual predators". And Ashann-Ra v. Virginia[nb 4] contains references to "inmates known to be predatory homosexuals [stalking] other inmates in the showers".

According to a study by Human Rights Watch, however, "The myth of the 'homosexual predator' is groundless. Perpetrators of rape typically view themselves as heterosexual and, outside of the prison environment, prefer to engage in heterosexual activity. Although gay inmates are much more likely than other inmates to be victimized in prison, they are not likely to be perpetrators of sexual abuse."[4] (see also situational homosexuality)

A related problem is that there is a tendency, among both prison officials and prisoners, to view victimization as proof of homosexuality: "The fact of submitting to rape—even violent, forcible rape—redefines [a prisoner] as 'a punk, sissy, queer.'" Officials sometimes take the view all sex involving a gay prisoner is necessarily consensual, meaning that victims known or perceived to be gay may not receive necessary medical treatment, protection, and legal recourse, and perpetrators may go unpunished and remain able to perpetrate abuse on their victims:[39]

I have been sexually assaulted twice since being incarcerated. Both times the staff refused to do anything except to lock me up and make accusations that I'm homosexual.

According to Andrea Cavanaugh Kern, a spokesperson for Stop Prisoner Rape, the combination of high rates of sexual assault against gay prisoners and high rates of HIV infection in the prison population is "a life-or-death issue for the LGBT community".[9]

While much of the data regards male prisoners, according to Amnesty International, "perceived or actual sexual orientation has been found to be one of four categories that make a female prisoner a more likely target for sexual abuse".[3]

Segregation
For their own safety, LGBT people in prison are sometimes placed in administrative segregation or protective custody.[40] Although homosexuality is "generally regarded as a factor supporting an inmate's claim to protective custody", homophobia among prison officials and a misperception among many guards that "when a gay inmate has sex with another man it is somehow by definition consensual" mean that access to such custody is not always easy or available.[41]

Another problem is that protective and disciplinary custody are often the same, which means that prisoners in "protective housing" are often held with the most violent inmates in highly restrictive and isolated settings—sometimes in more or less permanent lockdown or solitary confinement—that prevent them from participating in drug treatment, education and job-training programs, from having contact with other prisoners or outside visitors, or from enjoying privileges such as the right to watch television, listen to the radio, or even to leave their cells.[2] The degree of safety that protective custody provides depends on the facilities. Protective custody can provide a secure environment that is free from violence by other prisoners or it can isolate prisoners, and position them with a higher risk of violence by a correctional officer. Although the protective custody can offer some level of protection, the harmful physical and psychological impacts of isolation show that it is an unwanted alternative to assignment in the general population.[42]

In other cases, institutions may have special areas (known by such nicknames as the "queerentine", "gay tank", "queen tank", or "softie tank") for housing vulnerable inmates such as LGBT people, elderly or disabled prisoners, or informers.

LGBT Prison Segregation Within The United States

In San Francisco, for example, transgender inmates are automatically segregated from other prisoners. Nevertheless, according to Eileen Hirst, San Francisco Sheriff's Chief of Staff, being gay is not in itself enough to justify a request for protective housing: inmates requesting such housing must demonstrate that they are vulnerable.[43]

For financial or other reasons segregated housing is not always available in The United States. For instance at Rikers Island, New York City's largest jail, the segregated unit for LGBT prisoners, known as "gay housing", was closed in December 2005 citing a need to improve security.[43] The unit had opened in the 1970s due to concerns about abuse of LGBT prisoners in pretrial detention. The New York City Department of Corrections' widely criticised plan was to restructure the classification of prisoners and create a new protective custody system which would include 23-hour-per-day lockdown (identical to that mandated for disciplinary reasons) or moving vulnerable inmates to other facilities.[44] Whereas formerly all that was required was a declaration of homosexuality or the appearance of being transgender, inmates wanting protective custody would now be required to request it in a special hearing.[45]

Solitary confinement
Solitary confinement has become the prison system's preferred method to protect transgender inmates from other prisoners in cases involving sexual assault, harassment and physical violence. Advocates for transgender prisoners argue that this method only increases the harassment they receive from officers and various other staff members as reported by Injustice at Every Turn.[46]

Solitary Confinement Within The United States
In the report done by Injustice at Every Turn, 44% of transgender male respondents and 40% of transgender women respondents who were imprisoned reported being harassed by officers and/or other staff members of the prison system.[46] While in solitary confinement, transgender individuals are less likely to receive medical care.

Out of the respondents in the same report 12% of transgender individuals surveyed reported being denied routine non-transition related healthcare and 17% reported being denied hormone treatment. The number was disproportionately higher when transgender people of color reported lack of transition health care and hormone treatment with American Indians reporting 36% denial and Black and/or African American reporting a 30% denial rate.[46] The use of solitary confinement also lessens transgender inmate's access to programs and work assignments where they may be able to lessen their sentences, enter rehabilitation programs, or earn money to buy basic products such as soap and also lessens their chances to obtain parole or conditional release.[47]

Solitary confinement has also shown to affect the mental health of transgender prisoners. With the report filed by Injustice at Every Turn,[46] 41% of respondents reported attempted suicide. With transgender people of color, 56% of American Indian and 54% of multiracial individuals reported attempted suicide. The report also links the over-use of solitary confinement as a factor in the high rate of suicide attempts by transgender people of color within the prison system.[47]

Solitary Confinement in Canada
In cases where the incarcerated are assigned to prisons based on sex, rather than their gender-identity, complete segregation is often seen as the only viable way for ensuring safety. In the case of Synthia Kavanagh, she was assigned to a male institution despite explicit recommendations from the trial judge. As a result, Kavanagh was "placed in segregation over extended periods of her incarceration for the purpose of protection from self-harm or abuse by others. Segregation for prolonged periods is not only inhuman but [is additionally] unconducive to any prospect of stabilization or rehabilitation."[5]