Georgia changes policy on gender-affirming medical care for trans inmates

Ashley Diamond, a trans women incarcerated in Georgia, recently won the right to receive hormone therapy while in prison. She had received hormone therapy for 17 years prior to her arrest. The justice system in Georgia used a "freeze-frame policy," meaning that people undergoing hormone therapy before being arrested are able to continue treatment while incarcerated, but the state would not allow prisoners to begin or expand gender-affirming medical treatment. The Department of Justice (DoJ) backed Diamond's lawsuit, saying that "failure to provide individualized and appropriate medical care for inmates suffering from gender dysphoria violates the Eighth Amendment’s prohibition on cruel and unusual punishment."

Besides seeking to reinstate her medically necessarily hormone therapy, Ms. Diamond's lawsuit details extensive abuse she has suffered while incarcerated in several high security men's detention centers. A court hearing on Thursday failed to determine whether she is eligible for transfer to a lower security prison, a move which would help ensure her safety. Officials denied that she was moved to a particularly dangerous facility as retaliation for her lawsuit, and claimed that she had not experienced any sexual assault or harassment while imprisoned. The same officials used male pronouns while referring to Diamond, furthering the erasure of her trans identity.

Now, Diamond has resumed hormone therapy. In a broader victory, Georgia revealed that it has ended its blanket policy regarding medical treatment for transgender inmates, and will assess each case individually, in compliance with the DoJ's direction. However, Diamond's lawyers from the Southern Poverty Law Center (SPLC) say that her dosage is too small to be therapeutic, though they welcome it as a step in the right direction.

Diamond's lawyers are calling for immediate transfer and for her hormone therapy to comply with proper standards. In a statement, the SPLC said: “We are pleased to learn that the Georgia Department of Corrections has rescinded its prior, unconstitutional policy. We currently are reviewing the new policy to make certain that it complies with constitutional requirements and that it will ensure improved care for Ashley Diamond and others in her circumstances, who are among the most vulnerable and targeted for abuse and mistreatment in our prison systems.”

While the victory is encouraging, the system has a long way to go before it is an affirming place for trans inmates. As demonstrated by their use of male pronouns, many officials lack proper understanding of, or training on, issues that affect LGBT (and especially transgender) prisoners. Furthermore, courts around the country continue to deny inmates the right to certain gender-affirming medical treatments. Michelle-Lael Norsworthy, an inmate in California, was granted access to necessary medical treatment, but California's Attorney General has filed an appeal to block the ruling. Similarly, in Massachusetts, the First Circuit Court reversed a decision to grant Michelle Kosilek, a transgender inmate, access to treatment.

While it is essential to support transgender prisoners, we must also work to break the cycle of mass incarceration of trans folks. Approximately 1 in 6 transgender people have been incarcerated at some point, and the rate is even higher for trans women, at just over 1 in 5. Startlingly, black transgender women have an incarceration rate of almost 1 in 2 (47%). Many trans people are arrested for what are known as "survival crimes," such as stealing and quality of life offenses, which stems from an inability to secure stable housing and employment and affirming healthcare due to bias. Actively ending the policing of trans people means also actively combating pervasive discrimination aimed at the transgender community.