ABSTRACT

Objective:

The objective of the present study is to describe the sociodemographic and behavioral characteristics of a group of transgender women and travestis (TGW) with a history of incarceration and the institutional and social context of this experience in Brazil.

Methods:

The analyzed data were derived from the TransOdara Study, a cross-sectional study conducted in five Brazilian capitals from December 2019 to July 2021. Participants were recruited using the Respondent-Driven Sampling (RDS) technique, in which, after an initial formative and exploratory stage, the first participants were identified; in turn, these participants recruited up to six other transgender women and travestis for the research. The study’s outcome was the experience of incarceration throughout life, captured through the question: “Have you ever been arrested in your life?”

Results:

A total of 1,245 TGW were interviewed, of which 20.3% (n=253) experienced incarceration. Incarceration was more frequent among those aged 33 to 42 years (35.6%), with lower level of education (45.5%, p<0.001), engaged in informal work (30.3%), without a partner (67.2%), and among those who reported illicit drug use (66.4%). The majority (60.9%) of TGW were incarcerated with cisgender men, and the most common reasons for imprisonment were drug trafficking (30.4%) followed by robbery (29.2%). Over a quarter of the interviewees (26.3%) experienced assault, and 13.8% reported experiencing sexual violence during incarceration.

Conclusion:

The results emphasize the high prevalence of incarceration among TGW. This incarceration takes place in male wards and in a context of high rates of physical and sexual violence.

Keywords:
Transgender persons; Travestis; Prisoners; Prisons; Social vulnerability

INTRODUCTION

Transgender people suffer various forms of discrimination and gender-based violence, which restrict their access to resources necessary to achieve and maintain a dignified and healthy life, such as education, employment, and income¹1. Hughto JM, Reisner SL, Pachankis JE. Transgender stigma and health: a critical review of stigma determinants, mechanisms, and interventions. Soc Sci Med 2015; 147: 222-31. https://doi.org/10.1016/j.socscimed.2015.11.010
https://doi.org/10.1016/j.socscimed.2015... ,²2. Reisner SL, Poteat T, Keatley J, Cabral M, Mothopeng T, Dunham E, et al. Global health burden and needs of transgender populations: a review. Lancet 2016; 388(10042): 412-36. https://doi.org/10.1016/S0140-6736(16)00684-X
https://doi.org/10.1016/S0140-6736(16)00... . Consequently, transgender individuals often find themselves involved in informal activities, such as sex work, or even illicit activities such as drug trafficking³3. Reback CJ, Fletcher JB. HIV prevalence, substance use, and sexual risk behaviors among transgender women recruited through outreach. AIDS Behav 2014; 18(7): 1359-67. https://doi.org/10.1007/s10461-013-0657-z
https://doi.org/10.1007/s10461-013-0657-... .

The stigma and consequent social exclusion of transgender people impact incarceration rates and the way they are treated in the criminal justice system, causing the incarceration rates of transgender individuals to be higher than those of the general population⁴4. Poteat TC, Humes E, Althoff KN, Cooney EE, Radix A, Cannon CM, et al. Characterizing arrest and incarceration in a prospective cohort of transgender women. J Correct Health Care 2023; 29(1): 60-70. https://doi.org/10.1089/jchc.21.10.0118
https://doi.org/10.1089/jchc.21.10.0118... ,⁵5. James SE, Herman JL, Rankin S, Keisling M, Mottet L, Anafi M. The report of the 2015 U.S. transgender survey. Washington: National Center for Transgender Equality; 2016.. The experience of incarceration for transgender people leads to a maximization of the violations suffered in freedom: physical, psychological, and sexual violence, with an increased risk of HIV and other Sexually Transmitted Infections (STIs)⁶6. Brown GR, McDuffie E. Health care policies addressing transgender inmates in prison systems in the United States. J Correct Health Care 2009; 15(4): 280-91. https://doi.org/10.1177/1078345809340423
https://doi.org/10.1177/1078345809340423... ,⁷7. Brooke JM, Biernat K, Shamaris N, Skerrett V. The experience of transgender women prisoners serving a sentence in a male prison: a systematic review and meta-synthesis. Prison J 2022; 102(5): 542-64. https://doi.org/10.1177/00328855221121097
https://doi.org/10.1177/0032885522112109... .

Studies conducted in the United States show that transgender individuals who are detained have remarkably high rates of victimization by violence compared to other inmates. According to data from the National Inmate Survey (NIS) in the United States, almost 40% of transgender inmates have been victims of sexual violence, a significant contrast to the rate of only 4% among the other inmates⁸8. Truman JL, Morgan RE. Violent victimization by sexual orientation and gender identity, 2017–2020 [Internet]. U.S Department of Justice; 2022 [cited on July 31, 2023].. Another study showed that transgender inmates are thirteen times more likely to suffer sexual assault or rape during their incarceration⁹9. Jenness V, Sexton L. The centrality of relationships in context: a comparison of factors that predict the sexual and non-sexual victimization of transgender women in prisons for men. J Crime Justice 2022; 45(3): 259-69. https://doi.org/10.1080/0735648X.2021.1935298
https://doi.org/10.1080/0735648X.2021.19... .

In addition, transgender people face a series of mental health issues, such as low self-esteem, depression, chemical dependence, and suicide attempts, resulting from the adversities to which they are subjected during incarceration¹⁰10. Ledesma E, Ford CL. Health implications of housing assignments for incarcerated transgender women. Am J Public Health 2020; 110(5): 650-4. https://doi.org/10.2105/AJPH.2020.305565
https://doi.org/10.2105/AJPH.2020.305565... ,¹¹11. Reisner SL, Bailey Z, Sevelius J. Racial/ethnic disparities in history of incarceration, experiences of victimization, and associated health indicators among transgender women in the U.S. Women Health 2014; 54(8): 750-67. https://doi.org/10.1080/03630242.2014.932891
https://doi.org/10.1080/03630242.2014.93... . During the period of incarceration, this population is confronted with a series of challenges such as restricted access to medical care, scarce preventive measures against infectious diseases, lack of implementation of gender-affirming policies in the prison system, solitary confinement, and prolonged preventive detention⁸8. Truman JL, Morgan RE. Violent victimization by sexual orientation and gender identity, 2017–2020 [Internet]. U.S Department of Justice; 2022 [cited on July 31, 2023].,¹⁰10. Ledesma E, Ford CL. Health implications of housing assignments for incarcerated transgender women. Am J Public Health 2020; 110(5): 650-4. https://doi.org/10.2105/AJPH.2020.305565
https://doi.org/10.2105/AJPH.2020.305565... ,¹¹11. Reisner SL, Bailey Z, Sevelius J. Racial/ethnic disparities in history of incarceration, experiences of victimization, and associated health indicators among transgender women in the U.S. Women Health 2014; 54(8): 750-67. https://doi.org/10.1080/03630242.2014.932891
https://doi.org/10.1080/03630242.2014.93... . The incarceration of transgender people is correlated with the decrease in emotional support and social connections after returning to society, resulting in negative impacts on access to the formal labor market or other forms of socioeconomic inclusion¹²12. Scheidell JD, Dyer TV, Hucks-Ortiz C, Abrams J, Mazumdar M, Cleland C, et al. Characterisation of social support following incarceration among black sexual minority men and transgender women in the HPTN 061 cohort study. BMJ Open 2021; 11(9): e053334. https://doi.org/10.1136/bmjopen-2021-053334
https://doi.org/10.1136/bmjopen-2021-053... . In view of these challenging situations, this population usually resorts to psychoactive substances, which in turn entails other health risks⁶6. Brown GR, McDuffie E. Health care policies addressing transgender inmates in prison systems in the United States. J Correct Health Care 2009; 15(4): 280-91. https://doi.org/10.1177/1078345809340423
https://doi.org/10.1177/1078345809340423... ,⁷7. Brooke JM, Biernat K, Shamaris N, Skerrett V. The experience of transgender women prisoners serving a sentence in a male prison: a systematic review and meta-synthesis. Prison J 2022; 102(5): 542-64. https://doi.org/10.1177/00328855221121097
https://doi.org/10.1177/0032885522112109... ,⁹9. Jenness V, Sexton L. The centrality of relationships in context: a comparison of factors that predict the sexual and non-sexual victimization of transgender women in prisons for men. J Crime Justice 2022; 45(3): 259-69. https://doi.org/10.1080/0735648X.2021.1935298
https://doi.org/10.1080/0735648X.2021.19... .

Brazil ranks third globally in terms of prison population, with more than 800 thousand people deprived of freedom¹³13. Fair H, Walmsley R. World Prison Population List [Internet]. 13th edition. London: Institute for Crime & Justice Policy Research; 2021 [cited on July 31, 2023]. Available at: https://www.prisonstudies.org/sites/default/files/resources/downloads/world_prison_population_list_13th_edition.pdf
https://www.prisonstudies.org/sites/defa... . Most inmates in the country are men (94.5%), aged up to 34 years (55%), who identify as Black (54.5%), and with lower levels of education¹⁴14. Brasil. Ministério da Justiça. Dados MJ. Infopen – levantamento nacional de informações penitenciárias [Internet]. Brasil: Ministério da Justiça; 2017 [cited on July 31, 2023]. Available at: https://dados.mj.gov.br/dataset/infopen-levantamento-nacional-de-informacoes-penitenciarias
https://dados.mj.gov.br/dataset/infopen-... . The Brazilian prison system was highlighted as particularly worrisome in the 2014 United Nations (UN) report, emphasizing the vulnerability of the LGBTI+ population¹⁵15. Amnesty International. Amnesty International Report 2014/15 - Brazil [Internet]. UNHCR; 2015 [cited on July 15, 2023]. Available at: https://www.refworld.org/docid/54f07e1214.html
https://www.refworld.org/docid/54f07e121... . Furthermore, Brazil leads the global statistics of homicides motivated by sexual orientation and gender identity, intensifying the risks faced by the transgender population¹⁶16. US Department of State. 2013 Country Reports on Human Rights Practices - Brazil [Internet]. US; 2014. [cited on June 20, 2023] Available at: https://2009-2017.state.gov/documents/organization/220636.pdf
https://2009-2017.state.gov/documents/or... .

The investigation of the experience of incarceration among Brazilian transgender women and travestis is crucial for understanding the intricate vulnerability factors that permeate this reality. In Latin America, the term “travesti” is often adopted by transgender women who face a history marked by extreme vulnerability, in which prostitution assumes the predominant role as a source of livelihood¹⁷17. Amaral MS, Silva TC, Cruz KO, Toneli MJF. “Do travestismo às travestilidades”: uma revisão do discurso acadêmico no Brasil entre 2001-2010. Psicol Soc 2014; 26(2): 301-11. https://doi.org/10.1590/S0102-71822014000200007
https://doi.org/10.1590/S0102-7182201400... . In these cases, the use of the male reproductive organ to ensure their survival distances these women from the conventional medical concept of “transgender”¹⁸18. Pierce JM. I monster: embodying trans and travesti resistance in Latin America. Latin American Research Review 2020; 55(2): 305-21.. In order to preserve the political contextualization and not disregard the history of social and economic marginalization of travestis, in the present study we will use the term “transgender women and travestis” (TGW) to refer to the group under analysis.

The concept of vulnerability, derived from studies on HIV/AIDS¹⁹19. Parker R, Aggleton P. HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action. Soc Sci Med 2003; 57(1): 13-24. https://doi.org/10.1016/s0277-9536(02)00304-0
https://doi.org/10.1016/s0277-9536(02)00... , encompasses a range of individual and collective aspects related to the degree and mode of exposure to a certain disease or condition and, consequently, to greater or lesser access to adequate resources to protect oneself from the undesirable consequences of these situations²⁰20. Ayres JRCM, Franca Junior I, Calazans, GJ, Saletti Filho HC. O conceito de vulnerabilidade e as práticas de saúde: novas perspectivas e desafios. Rio de Janeiro: Fiocruz; 2003.. This approach focuses on interrelated components: individual vulnerability, which is associated with physical, mental, or behavioral factors increasing the risk of a disease or condition; social vulnerability, which examines cultural and economic dimensions and institutional factors that may determine exposure to diseases, injuries or health conditions; and programmatic vulnerability, which investigates how policies and programs interfere in social and individual conditions¹⁹19. Parker R, Aggleton P. HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action. Soc Sci Med 2003; 57(1): 13-24. https://doi.org/10.1016/s0277-9536(02)00304-0
https://doi.org/10.1016/s0277-9536(02)00... ,²⁰20. Ayres JRCM, Franca Junior I, Calazans, GJ, Saletti Filho HC. O conceito de vulnerabilidade e as práticas de saúde: novas perspectivas e desafios. Rio de Janeiro: Fiocruz; 2003..

Identifying violent victimization, particularly sexual violence, as well as other risk issues during the period of incarceration, is essential to assist the health system that will welcome this population segment after incarceration so that it is prepared to ensure priority care and safe and humane care strategies²¹21. Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, DeCuypere G, Feldman J, et al. Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. Int J Transgend 2012; 13(4): 165-232. https://doi.org/10.1080/15532739.2011.700873
https://doi.org/10.1080/15532739.2011.70... . Despite the increased visibility of the transgender population, studies on incarcerated transgender women are still scarce in the Brazilian and global literature²²22. Sevelius J, Jenness V. Challenges and opportunities for gender-affirming healthcare for transgender women in prison. Int J Prison Health 2017; 13(1): 32-40. https://doi.org/10.1108/IJPH-08-2016-0046
https://doi.org/10.1108/IJPH-08-2016-004... Thus, in this article, we aim to analyze the experience of incarceration of transgender women and travestis in five Brazilian capitals.

METHODS

The data analyzed in this article derive from the Estudo de Prevalência da Sífilis e outras Infecções Sexualmente Transmissíveis entre Travestis e Mulheres Transexuais no Brasil: Cuidado e Prevenção (TransOdara)²³23. Veras MASM, Pinheiro TF, Galan L, et al. TransOdara study: The challenge of integrating methods, settings and procedures during the COVID-19 pandemic in Brazil. Rev Bras Epidemiol. 2024; 27(Suppl 1): e240002.supl.1. https://doi.org/10.1590/1980-549720240002.supl.1
https://doi.org/10.1590/1980-54972024000... [“Study on the Prevalence of Syphilis and other Sexually Transmitted Infections among Travestis and Transgender Women in Brazil: Care and Prevention”], carried out in five Brazilian capitals (São Paulo, Porto Alegre, Campo Grande, Salvador, and Manaus). We recruited the participants using the Respondent-Driven Sampling (RDS) model²⁴24. Heckathorn DD. Respondent-driven sampling ii: deriving valid population estimates from chain-referral samples of hidden populations. Soc Probl 2002; 49(1): 11-34. https://doi.org/10.1525/sp.2002.49.1.11
https://doi.org/10.1525/sp.2002.49.1.11... . We identified and invited the first participants after an initial formative and exploratory stage; in turn, these participants recruited up to six other transgender women and travestis for the research.

The eligibility criteria for the study were to identify as a travesti, woman, transgender woman, or other self-designation that implies a female transgender identity not consonant with the male sex assigned at birth; to be 18 years of age or older; to live, work, or study in the cities of the study; and to have a referral coupon provided by a known recruiter, based on the RDS technique. The exclusion criteria were to be under the influence of alcohol or a psychoactive substance in such a way as to make the interview unfeasible.

With the aid of trained researchers, all participants answered a questionnaire containing questions about sociodemographic factors, sexual behavior, drug and alcohol abuse, and experience of violence and incarceration. In addition, the interviewees underwent rapid tests for HIV, Syphilis, Hepatitis B and C, and provided samples of blood, urine, and secretions for further laboratory tests. The project was approved by the Research Ethics Committee of the Santa Casa de Misericórdia de São Paulo (CAAE 05585518.7.0000.5479; opinion n°: 3.126.815 – 30/01/2019), as well as by other participating institutions²³23. Veras MASM, Pinheiro TF, Galan L, et al. TransOdara study: The challenge of integrating methods, settings and procedures during the COVID-19 pandemic in Brazil. Rev Bras Epidemiol. 2024; 27(Suppl 1): e240002.supl.1. https://doi.org/10.1590/1980-549720240002.supl.1
https://doi.org/10.1590/1980-54972024000... . All participants signed an Informed Consent Form to participate in the study.

Variables

The outcome of the present study is the experience of incarceration in life. The question used to construct the outcome was as follows: “Have you ever been arrested in your life?” Initially, a comparison was made between incarcerated and non-incarcerated TGW in order to evaluate possible variables associated with the outcome.

Seeking to understand the experience during the prison period, for participants who reported the experience of incarceration, the reason for the most recent arrest was investigated (open-ended question, subsequently categorized), with whom the participant was incarcerated (only with men; only with women; with other travestis and transgender people; or in a specific ward for the LGBTI+ population); and experiences of violence (physical and sexual) suffered in prison. Transgender women and travestis who reported spending only one night in prison (42 participants) were not considered in the analyses. The experience of one night detained in a police station is characterized by the penal code as preventive detention or “confinement to prison,” a situation that presupposes evidence of authorship of the crime, but which awaits evidence (Code of Criminal Procedure – Decree-Law 3689/41). In this case, prison confinement is not synonymous with incarceration and would not be sufficient to constitute exposure to the risks explored in this study as a result of the experience of incarceration.

In the analyses, sociodemographic and behavioral variables were also used. The sociodemographic variables were: age group (18 to 24, 25 to 32, 33 to 42, and 43 years or older); self-reported ethnicity/skin color (White, Black, and Asian/Indigenous); level of education (some elementary school; elementary school/some high school; high school/some college); housing situation (own house, rented house, temporarily living with relatives or friends, or homeless); marital status (married or living with a partner; dating or casual dating; separated, widow or single), and whether or not the interviewee is a sex worker. The income variable was categorized based on the minimum wage in force at the time of the study (BRL 1,045.00, about USD 217.15). The main source of income was categorized as sporadic work/without a formal employment contract (also reported as “odd jobs”), sex worker, unemployed, retired or housewife, and work with a formal employment contract. The behavioral variables used were illicit drug use in the last 12 months and information on the first sexual intercourse (whether consensual or forced). Data on verbal, physical, and sexual violence suffered in the 12 months prior to the study were also considered.

Statistical analysis

The analyses were performed using the Statistical Package for Social Sciences (SPSS, version 22.0). The sample was described by N of the category and percentage. The comparison between the groups was made using Pearson’s χ² homogeneity test. Variables with a p-value of less than or equal to 5% were considered statistically significant.

RESULTS

A total of 1,245 TGW were included in this study. Among them, the experience of incarceration was reported by 20% (n=253). Those who reported spending only one night at the police station (3.3%, n=42) did not have their experience considered as being an incarceration experience. In Table 1 we present sociodemographic and behavioral data on the TGW, stratified according to the experience of incarceration.

The experience of incarceration was reported more frequently among TGW aged between 33 and 42 years (35.6%, p<0.001), who identify as Black (73.5%), with lower level of education (p<0.001), living in a rented house (p<0.001), and without a partner (p=0.035). There was a predominance of incarcerated TGW who had a history of drug use in the 12 months prior to the study (66.4%, p<0.001). About 30% of transgender women and travestis with a history of incarceration were sex workers at the time of the study.

In Table 2 we show the experience of violence suffered by TGW during life and in the last year, stratified by the experience of incarceration. In the last 12 months, 48.8% of incarcerated transgender women and travestis reported having been victims of verbal violence, and 24.2% of physical violence. Lifetime sexual violence was prevalent in the whole sample, and it was 52.6% among incarcerated TGW. Having suffered physical violence in the last 12 months was associated with the experience of incarceration among the interviewed TGW (p<0.001).

In Table 3 we present the experiences during incarceration. Most of the TGW reported having been imprisoned with cisgender men (60.9%). Just over 30% of the TGW reported having stayed in a specific ward with other transgender women or travestis, and 4.7% of them reported having been arrested along with other cisgender women.

The most frequent reasons for arrest were drug trafficking (30.4%) and robbery (29.2%). Although sex work is not a crime in Brazil, 8.8% of TGW reported having been arrested for prostitution. The reason why the TGW were incarcerated was an open-ended question (and not an analysis of their criminal cases). Therefore, other reasons emerged in the study such as “being in the wrong place/wrong time.”

The experience of violence within prison was frequent among the TGW. More than a quarter of the interviewees were assaulted during incarceration (26.3%) and 13.8% reported having suffered sexual violence during incarceration.

DISCUSSION

The present study aimed to evaluate the experience of incarceration among TGW in Brazil. The results showed that 20.3% of the analyzed sample (n=253) had experienced being deprived of freedom at least once in their lives. The prevalence of incarceration observed in our study is similar to that reported in other investigations, ranging from 19.3¹¹11. Reisner SL, Bailey Z, Sevelius J. Racial/ethnic disparities in history of incarceration, experiences of victimization, and associated health indicators among transgender women in the U.S. Women Health 2014; 54(8): 750-67. https://doi.org/10.1080/03630242.2014.932891
https://doi.org/10.1080/03630242.2014.93... to 21%⁴4. Poteat TC, Humes E, Althoff KN, Cooney EE, Radix A, Cannon CM, et al. Characterizing arrest and incarceration in a prospective cohort of transgender women. J Correct Health Care 2023; 29(1): 60-70. https://doi.org/10.1089/jchc.21.10.0118
https://doi.org/10.1089/jchc.21.10.0118... . Among the TGW who participated in this research and most frequently reported the experience of incarceration, those aged between 33 and 42 years, with a lower level of education, absence of regular occupation, history of illicit drug use, and report of physical violence in the last 12 months stand out.

According to the current literature, several individual risk factors are correlated with the experience of incarceration among TGW, including low level of education, low socioeconomic status, engagement in sex work, and homelessness⁴4. Poteat TC, Humes E, Althoff KN, Cooney EE, Radix A, Cannon CM, et al. Characterizing arrest and incarceration in a prospective cohort of transgender women. J Correct Health Care 2023; 29(1): 60-70. https://doi.org/10.1089/jchc.21.10.0118
https://doi.org/10.1089/jchc.21.10.0118... ,¹¹11. Reisner SL, Bailey Z, Sevelius J. Racial/ethnic disparities in history of incarceration, experiences of victimization, and associated health indicators among transgender women in the U.S. Women Health 2014; 54(8): 750-67. https://doi.org/10.1080/03630242.2014.932891
https://doi.org/10.1080/03630242.2014.93... ,²⁵25. Grant JM, Mottet LA, Tanis J. Injustice at every turn: a report of the national transgender discrimination survey [Internet]. Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force; 2011 [cited on July 31, 2023]. Available at: https://www.thetaskforce.org/resources/injustice-every-turn-report-national-transgender-discrimination-survey/
https://www.thetaskforce.org/resources/i... . Sex work emerges as a significant possible predictor of incarceration for TGW, as more than one-fifth of the study participants had sex work as their main source of income, and of these, almost 30% had been detained at some point in their lives. As pointed out by Hughto et al., 27% of incarcerated transgender women were or had been sex workers, being 2.6 times more likely to have engaged in sex work compared to non-incarcerated women²⁶26. Hughto JMW, Reisner SL, Kershaw TS, Altice FL, Biello KB, Mimiaga MJ, et al. A multisite, longitudinal study of risk factors for incarceration and impact on mental health and substance use among young transgender women in the USA. J Public Health (Oxf) 2019; 41(1): 100-9. https://doi.org/10.1093/pubmed/fdy031
https://doi.org/10.1093/pubmed/fdy031... . The higher incidence of incarceration among TGW who were homeless, as well as those who temporarily lived with relatives or friends, also finds parallels in this study, in which almost half (48%) of incarcerated transgender women had already experienced homelessness²⁶26. Hughto JMW, Reisner SL, Kershaw TS, Altice FL, Biello KB, Mimiaga MJ, et al. A multisite, longitudinal study of risk factors for incarceration and impact on mental health and substance use among young transgender women in the USA. J Public Health (Oxf) 2019; 41(1): 100-9. https://doi.org/10.1093/pubmed/fdy031
https://doi.org/10.1093/pubmed/fdy031... .

In addition to these individual characteristics, there are social factors, such as discrimination concerning gender identity, which may have implications for higher school dropouts and difficulty in accessing the labor market¹1. Hughto JM, Reisner SL, Pachankis JE. Transgender stigma and health: a critical review of stigma determinants, mechanisms, and interventions. Soc Sci Med 2015; 147: 222-31. https://doi.org/10.1016/j.socscimed.2015.11.010
https://doi.org/10.1016/j.socscimed.2015... ,²⁶26. Hughto JMW, Reisner SL, Kershaw TS, Altice FL, Biello KB, Mimiaga MJ, et al. A multisite, longitudinal study of risk factors for incarceration and impact on mental health and substance use among young transgender women in the USA. J Public Health (Oxf) 2019; 41(1): 100-9. https://doi.org/10.1093/pubmed/fdy031
https://doi.org/10.1093/pubmed/fdy031... . The structural stigma associated with transgenderism²⁷27. Magno L, Dourado I, Silva LAV. Estigma e resistência entre travestis e mulheres transexuais em Salvador, Bahia, Brasil. Cad Saúde Pública 2018; 34(5): e00135917. https://doi.org/10.1590/0102-311X00135917
https://doi.org/10.1590/0102-311X0013591... can also affect TGW in the treatment they receive from law enforcement and the justice system, placing them in a situation of vulnerability to the experience of incarceration.

In Brazil, as in other countries, transgender women who have not undergone sex reassignment surgeries are placed in male facilities⁴4. Poteat TC, Humes E, Althoff KN, Cooney EE, Radix A, Cannon CM, et al. Characterizing arrest and incarceration in a prospective cohort of transgender women. J Correct Health Care 2023; 29(1): 60-70. https://doi.org/10.1089/jchc.21.10.0118
https://doi.org/10.1089/jchc.21.10.0118... ,⁷7. Brooke JM, Biernat K, Shamaris N, Skerrett V. The experience of transgender women prisoners serving a sentence in a male prison: a systematic review and meta-synthesis. Prison J 2022; 102(5): 542-64. https://doi.org/10.1177/00328855221121097
https://doi.org/10.1177/0032885522112109... , where they are potentially exposed to a higher risk of verbal, physical, and sexual assault¹1. Hughto JM, Reisner SL, Pachankis JE. Transgender stigma and health: a critical review of stigma determinants, mechanisms, and interventions. Soc Sci Med 2015; 147: 222-31. https://doi.org/10.1016/j.socscimed.2015.11.010
https://doi.org/10.1016/j.socscimed.2015... ,²⁸28. Clark KA, Hughto JMW, Pachankis JE. “What’s the right thing to do?” Correctional healthcare providers’ knowledge, attitudes and experiences caring for transgender inmates. Soc Sci Med 2017; 193: 80-9. https://doi.org/10.1016/j.socscimed.2017.09.052
https://doi.org/10.1016/j.socscimed.2017... . In this study, a considerable part of the sample (60.9%) of TGW was allocated to male prisons. According to Jeness and Sexton, men’s prisons are environments of expanded policing for sexual and gender nonconformities. Individuals who transgress gender norms are placed lower in the hierarchy of social status, are less respected, and become extremely vulnerable to violence⁹9. Jenness V, Sexton L. The centrality of relationships in context: a comparison of factors that predict the sexual and non-sexual victimization of transgender women in prisons for men. J Crime Justice 2022; 45(3): 259-69. https://doi.org/10.1080/0735648X.2021.1935298
https://doi.org/10.1080/0735648X.2021.19... . As ways of dealing with this violence, transgender women end up “voluntarily” becoming sexually involved with other prisoners to avoid being assaulted²⁹29. Johnson RG, McCandless S, Renderos H. An exploratory study of transgender inmate populations in Latin America. Public Integrity 2019; 22(1): 1-14. http://dx.doi.org/10.1080/10999922.2018.1557027
https://doi.org/10.1080/10999922.2018.15... . The qualitative study by Oliveira et al., conducted in Brazil, also shows that the incarceration of travestis in male wards amplifies other forms of violence intrinsic to the prison system, such as rebellions, in which travestis, along with sexual abusers, are considered the main targets of inmates³⁰30. Oliveira JW, Rosato CM, Nascimento AMR, Granja E. “Sabe a minha identidade? Nada a ver com genital”: Vivências travestis no cárcere. Psicol Ciênc Prof 2018; 38(spe2): 159-74. https://doi.org/10.1590/1982-3703000212382
https://doi.org/10.1590/1982-37030002123... .

To meet the specificities of the LGBTI+ population deprived of freedom, the Council of Justice published Resolution No. 348, of 10/13/2020, which regulates the guidelines and procedures to be adopted by the Judicial Branch in the treatment of LGBTI+ people deprived of freedom³¹31. Brasil. Conselho Nacional de Justiça. Manual Resolução no 348/2020: procedimentos relativos a pessoas LGBTI acusadas, rés, condenadas ou privadas de liberdade: orientações a tribunais, magistrados e magistradas voltadas à implementação da Resolução no 348/2020, do Conselho Nacional de Justiça [Internet]. Brasília: Conselho Nacional de Justiça; 2021 [ited on July 31, 2023]. Available at: https://www.cnj.jus.br/wp-content/uploads/2021/06/manual_resolucao348_LGBTI.pdf
https://www.cnj.jus.br/wp-content/upload... . The document assures transgender women and travestis the same rights reserved for cisgender women, as well as the judge’s obligation to inquire about the preference for incarceration in a female or male unit or, in cases where available, in a specific unit for the LGBTI+ population. Despite a great advance in terms of dignified treatment of the population of TGW, this resolution still faces major obstacles to its implementation: lack of training of professionals in the judicial and prison system, lack of specific wards, precariousness of health care adequate to the specificities of this group in prisons, among others³²32. Brasil. Secretaria Nacional de Políticas Penais. Dados estatísticos do sistema penitenciário [Internet]. Brasília: Ministério da Justiça e Segurança Pública; 2022 [cited on July 15, 2023]. Available at: https://www.gov.br/senappen/pt-br/servicos/sisdepen
https://www.gov.br/senappen/pt-br/servic... .

In the present study, drug trafficking was the main reason for the incarceration of TGW. This datum is similar to the situation of cisgender women. According to data from the Brazilian Ministry of Justice and Public Security, the female prison population is marked by convictions for drug crimes (drug trafficking and association for trafficking, Law 6.368/76 and Law 11.343/06), with 55.4% of women being incarcerated in this group of crimes, while 27.5% of men are in the same situation³²32. Brasil. Secretaria Nacional de Políticas Penais. Dados estatísticos do sistema penitenciário [Internet]. Brasília: Ministério da Justiça e Segurança Pública; 2022 [cited on July 15, 2023]. Available at: https://www.gov.br/senappen/pt-br/servicos/sisdepen
https://www.gov.br/senappen/pt-br/servic... . In Brazil, female imprisonment is combined with indicators of social vulnerability of these women such as unemployment, low level of education, and history of drug abuse³³33. Brasil. Ministério da Justiça e Segurança Pública. Departamento Penitenciário Nacional. Coordenação de Atenção às Mulheres e Grupos Específicos. Informação no 95/2022/COAMGE/CGCAP/DIRPP/DEPEN [Internet]. Brasília: Ministério da Justiça e Segurança Pública; 2023. [ited on July 31, 2023]. Available at: https://www.gov.br/senappen/pt-br/servicos/sisdepen/relatorios/populacao-carceraria/presos-lgbti/presos-lgbti-2022.pdf
https://www.gov.br/senappen/pt-br/servic... . Among the current explanations for the greater participation of cisgender women in drug trafficking is their relationship with intimate partners or family members, who are already involved in drug trafficking³¹31. Brasil. Conselho Nacional de Justiça. Manual Resolução no 348/2020: procedimentos relativos a pessoas LGBTI acusadas, rés, condenadas ou privadas de liberdade: orientações a tribunais, magistrados e magistradas voltadas à implementação da Resolução no 348/2020, do Conselho Nacional de Justiça [Internet]. Brasília: Conselho Nacional de Justiça; 2021 [ited on July 31, 2023]. Available at: https://www.cnj.jus.br/wp-content/uploads/2021/06/manual_resolucao348_LGBTI.pdf
https://www.cnj.jus.br/wp-content/upload... . There are also studies that evidence a personal choice, in which the woman would have the opportunity to gain greater recognition and social status in her community³⁴34. Cortina MOC. Mulheres e tráfico de drogas: aprisionamento e criminologia feminista. Estudos Feministas 2015; 23(3): 761-78. https://doi.org/10.1590/0104-026X2015v23n3p761
https://doi.org/10.1590/0104-026X2015v23... ,³⁵35. França MHO. Criminalidade e prisão feminina: uma análise da questão de gênero. Revista Ártemis. 2014; 18(1): 212-27. https://doi.org/10.15668/1807-8214/artemis.v18n1p212-227
https://doi.org/10.15668/1807-8214/artem... .

For transgender women and travestis, however, there is little research on the topic. The involvement of TGW with drug trafficking may be associated with a higher prevalence of illicit drug use by this population²2. Reisner SL, Poteat T, Keatley J, Cabral M, Mothopeng T, Dunham E, et al. Global health burden and needs of transgender populations: a review. Lancet 2016; 388(10042): 412-36. https://doi.org/10.1016/S0140-6736(16)00684-X
https://doi.org/10.1016/S0140-6736(16)00... ,³3. Reback CJ, Fletcher JB. HIV prevalence, substance use, and sexual risk behaviors among transgender women recruited through outreach. AIDS Behav 2014; 18(7): 1359-67. https://doi.org/10.1007/s10461-013-0657-z
https://doi.org/10.1007/s10461-013-0657-... . As sex work is not considered a crime in the country, the mere possession of drugs by TGW sex workers can be used as a reason for their arrest. In addition, their involvement with drug trafficking may be due to factors such as discrimination and prejudice which culminate in a lack of formal work opportunities, in such a way that drug trafficking may be perceived by them as a potential source of income. A qualitative study conducted with transgender women imprisoned in Nicaragua and El Salvador demonstrated that the lack of formal employment opportunities was the main reported reason for them to commit crimes²⁹29. Johnson RG, McCandless S, Renderos H. An exploratory study of transgender inmate populations in Latin America. Public Integrity 2019; 22(1): 1-14. http://dx.doi.org/10.1080/10999922.2018.1557027
https://doi.org/10.1080/10999922.2018.15... . As in our results, the reasons for imprisonment cited in the study were drug trafficking, robbery, and prostitution²⁹29. Johnson RG, McCandless S, Renderos H. An exploratory study of transgender inmate populations in Latin America. Public Integrity 2019; 22(1): 1-14. http://dx.doi.org/10.1080/10999922.2018.1557027
https://doi.org/10.1080/10999922.2018.15... .

The profile of TGW with experiences of incarceration evidences the situation of greater social vulnerability of these transgender women and travestis. The stigma associated with transgenderism²⁷27. Magno L, Dourado I, Silva LAV. Estigma e resistência entre travestis e mulheres transexuais em Salvador, Bahia, Brasil. Cad Saúde Pública 2018; 34(5): e00135917. https://doi.org/10.1590/0102-311X00135917
https://doi.org/10.1590/0102-311X0013591... can have direct implications on living conditions, such as low level of education, difficult insertion in the labor market, sex work, and homelessness, making incarceration a frequent situation. Despite the legal advances in the treatment of the LGBTI+ population deprived of freedom, which grants TGW the same rights reserved for cisgender women, in this article we demonstrate that the percentage of TGW with violation of rights was high, and the difficulties in effectively guaranteeing the rights of this population are evidenced.

Several forms of violence, in addition to those occurring in the prison environment, showed high prevalence in the studied sample. These data reflect the high incidence of gender-based violence (GBV) faced by TGW in different contexts³⁶36. Wirtz AL, Poteat T, Malik M, Glass N. Gender-based violence against transgender people in the united states: a call for research and programming. Trauma, Violence, & Abuse 2018; 21(2): 227-41. http://dx.doi.org/10.1177/1524838018757749
https://doi.org/10.1177/1524838018757749... . GBV is an umbrella term that encompasses any form of physical, sexual, or emotional violence perpetrated against a person’s will and stemming from power inequalities based on gender roles³⁷37. United Nations General Assembly. Declaration on the elimination of violence against women [Internet]. Geneva; 1993 [ited on July 31, 2023]. Available at: https://www.ohchr.org/en/instruments-mechanisms/instruments/declaration-elimination-violence-against-women
https://www.ohchr.org/en/instruments-mec... . As highlighted by Wirtz et al., the failure of the State to recognize the identity of transgender people and to protect them against discrimination contributes to the creation of environments conducive to the occurrence of violence, which is sometimes tolerated or even normalized due to the absence of adequate sanctions³⁶36. Wirtz AL, Poteat T, Malik M, Glass N. Gender-based violence against transgender people in the united states: a call for research and programming. Trauma, Violence, & Abuse 2018; 21(2): 227-41. http://dx.doi.org/10.1177/1524838018757749
https://doi.org/10.1177/1524838018757749... .

The fact that the incarceration of TGW takes place in female or male units or specific units for the LGBTI+ population may be related to the various situations of violence experienced in prison. Despite the robust evidence that the allocation of TGW in male wards is detrimental to ensuring the physical and psychological well-being of these inmates⁴4. Poteat TC, Humes E, Althoff KN, Cooney EE, Radix A, Cannon CM, et al. Characterizing arrest and incarceration in a prospective cohort of transgender women. J Correct Health Care 2023; 29(1): 60-70. https://doi.org/10.1089/jchc.21.10.0118
https://doi.org/10.1089/jchc.21.10.0118... ,⁶6. Brown GR, McDuffie E. Health care policies addressing transgender inmates in prison systems in the United States. J Correct Health Care 2009; 15(4): 280-91. https://doi.org/10.1177/1078345809340423
https://doi.org/10.1177/1078345809340423... ,⁷7. Brooke JM, Biernat K, Shamaris N, Skerrett V. The experience of transgender women prisoners serving a sentence in a male prison: a systematic review and meta-synthesis. Prison J 2022; 102(5): 542-64. https://doi.org/10.1177/00328855221121097
https://doi.org/10.1177/0032885522112109... ,⁹9. Jenness V, Sexton L. The centrality of relationships in context: a comparison of factors that predict the sexual and non-sexual victimization of transgender women in prisons for men. J Crime Justice 2022; 45(3): 259-69. https://doi.org/10.1080/0735648X.2021.1935298
https://doi.org/10.1080/0735648X.2021.19... , we emphasize the need for studies that analyze the experience of TGW incarceration with cisgender women or in specific wards for the LGBTI+ population.

To ensure the rights of transgender women and travestis deprived of freedom in Brazil, it is essential to implement government initiatives in line with the guidelines and norms recommended by the resolution of the Council of Justice. In addition, public policy initiatives are necessary to mitigate the contexts of vulnerability that affect this population. These measures include the implementation of quota policies in higher education, the adoption of affirmative policies in the labor market to expand employment opportunities, the creation of housing policies and, finally, the development of policies that promote greater gender equity. These collective actions are crucial to promote the inclusion, protection, and guarantee of the fundamental rights of this community.

It is worth highlighting some limitations inherent in the present study. The main one is related to the difficulty in establishing the temporal relationship between incarceration and other situations experienced by the interviewees such as the sociodemographic status. In addition, considering that the main focus of the research was not incarceration, few questions on this specific topic were included in the questionnaire. The choice of the RDS technique, due to the nature of the population that is difficult to access, results in convenience sampling. Furthermore, the study was conducted in five Brazilian state capitals, which do not cover all states or TGW living in rural areas. Consequently, the results should be interpreted with caution and cannot be generalized to the entire population of transgender women and travestis. Considering the need for a more comprehensive understanding, other studies investigating diverse experiences of TGW during incarceration, especially in Latin American countries, would be valuable to broaden the understanding of this panorama.

ACKNOWLEDGMENTS:

The authors would like to thank all the transgender women and travestis who participated in the TransOdara study in the five capitals of Brazil. We would also like to thank the support of the Ministry of Health and the Pan American Health Organization (PAHO), which was essential for us to conduct the study.

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