Public Health Perspectives on Queer Liberation & the Necessity of Abolition

By Emilie Lum

Illustration by Junyue Ma

 

Why is it important to talk about abolition in the context of public health? I argue that to be a health advocate for health equity necessitates being an advocate for abolition. Abolition is the coalition of many movements to end all systems of oppression and to transform our society into a place of liberation for everyone. Abolitionist frameworks are rooted in transformative justice practices, which seek to find alternative approaches to both preventing harm and holding others accountable for harm they have inflicted. One of the primary goals for abolitionists is the removal of policing and incarceration systems. As public health professionals who advocate for the health and well-being of all people, it is essential to understand and mitigate the physical, emotional, and mental harm imposed by the prison-industrial complex. Policing, surveillance, and the incarceration system perpetuate harm to people who are facing oppression conditions based on their identity. Those who are BlPOC (Black, Indigenous People of Color), poor, disabled, LGBTQIA+, or work as sex-workers are most disproportionately harmed by the incarceration system: the harm that these communities experience is a matter of health equity. Those who are faced against several axes of oppression can be subjected to more extreme kinds of violence reproduced within the incarceration system. This paper highlights the experiences of the LGBTQIA+ community and the hopes for Queer liberation, especially those of color, who are particularly at risk to demonstrate the pressing necessity of abolitionist frameworks in public health care approaches. However, it is essential to note how this community is just one example of how different communities of people navigate the violence and oppression imposed by the incarceration system.  

In her own op-ed published in 2021, Ashley Diamond– a Black trans woman from Georgia– narrates her experiences with violent sexual abuse and rape while being transferred across several different men’s prisons for three years. Not only was she denied protection and could not move to a facility where she would be safe, but she was also repeatedly refused the hormones and gender-affirming care she needed. Correctional officers and fellow inmates have relentlessly subjected her to harassment because of her trans identity.¹ While one story cannot be representative of the entire community, Ashley’s narrative is testament to the ways that the LGBTQIA+ community face particular kinds of challenges before, during, and after incarceration. For example, in 2013, Ashely was placed into solitary confinement solely on the basis of “‘pretending to be a woman.’”¹ Once released on early parole, Ashley continued to face multiple barriers and challenges as a result of being a Black trans woman under strict parole supervision in her hometown: this included facing harassment by the Ku Klux Klan, repeated home vandalization, and consistent targeting by the police. She was eventually sent back to prison in 2019 for breaking her parole by visiting a treatment center in Florida to manage her PTSD. While in prison, the repeated denial of gender-based healthcare triggered gender dysphoria for Ashley– resulting in a severe deterioration of her mental health, threatening her well-being and safety.¹ 

Ashley’s story is one of the countless experiences of Black transgender folks facing particularly cruel treatment while incarcerated. According to the National Library of Medicine, “Transgender women, especially those of color, experience disproportionate rates of incarceration, high rates of victimization while incarcerated, and associated negative health-related indicators.”²   Hyperincarceration systematically targets transgender people and transgender people of color, subjecting them to state-sanctioned violence once imprisoned. About one in every six transgender people have been incarcerated, while the rate for Black transgender folks increases to one in every two people.³  As the Sylvia Riveria Law Project describes it: “‘Over-policing and profiling of low-income people and of trans and gender-nonconforming people intersect, producing a far higher risk than average of imprisonment, police harassment and violence for low-income trans people.’”³  Transgender women incarcerated are at risk for significant health disparities and are in the most need of comprehensive medical services.³  Additionally, trans folks need access to gender-affirming care, which is typically extremely difficult for them.⁴ Prisons frequently deny gender-affirming care– which can include “puberty suppression, hormone therapy, and gender-affirming surgeries”– to transgender folks.⁴  This kind of care is a basic necessity for trans folks and is also crucial to treating gender dysphoria. Left untreated, gender dysphoria can cause folks to experience heightened anxiety and depression, putting them at much greater risk for self-harm and suicide.⁴ The lack of adequate healthcare for trans people jeopardizes their well-being and their safety. The violence inflicted upon transgender communities– particular trans women of color– is the cumulative result of an overwhelming number of social, economic, and political factors that are a product of our current state.

Across the board, solitary confinement has been considered a torturous and inhumane practice. Yet, queer and transgender folks, especially trans women of color, are disproportionately forced into solitary confinement.⁵ A study done by an LGBTQIA+ abolitionist group called Black and Pink reported that 85 percent of incarcerated LGBTQIA+ folks had been placed in solitary confinement.  Correctional staff will use the gender identity of gender non-conforming folks to justify solitary confinement under the guise of safety.⁵ The damage from solitary confinement is irrevocable. Recent research reveals that solitary confinement shortens lives and causes other forms of irreversible emotional, physical, and mental damage.⁶ This type of punishment is one of several causes why prisons further exaggerate pre-existing mental health struggles for folks who are incarcerated. While only 6 to 8 percent of the prison population is in solitary confinement, about half of suicides are committed by those in solitary confinement.⁶ Folks in solitary confinement often are unable to receive proper treatment for their mental health conditions. Additionally, entering solitary confinement can make someone predisposed to developing a mental health condition due to the compounding effects of isolation.⁶ Solitary confinement is a practice that is considered torture, and a practice that disproportionately impacts trans and LGBTQIA+ folks.  

There is a violent history of the criminalization of Queerness alongside the targeting of Queer bodies and spaces. The Stonewall Uprising of 1969– one of the most prominent Queer protests against state-sanctioned violence and surveillance– was led by trans women  in the wake of repeated NYPD raids targeting gay bars across the city.⁷ LGBTQIA+ communities have had to operate and exist under centuries of laws prohibiting homosexuality as well as social stigma against queer and gender non-conforming practices. For example, laws promoting the criminalization of HIV– which still exist in 33 states to this day– disproportionately targets gay and trans people of color.⁸ Therefore, it is not surprising to learn that LGBTQIA+ community members are disproportionately overrepresented in the incarceration system in the United States. And when incarcerated, they are subjected to unique violence and treatment because of their identities. LGBTQIA+ youth and adults are overrepresented in incarcerated populations in the juvenile justice system.⁹ Furthermore, LGBTQIA+ folks who are people of color are disproportionately criminalized. Sixteen percent of transgender people, and 47 percent of Black transgender people, are incarcerated.¹² Black transgender folks are incarcerated at a rate that is ten times higher than the general population, according to the National Center for Transgender Equality.⁵  

Not only does the incarceration system criminalize mental health struggles, but it continues to exacerbate mental health issues for those incarcerated. People struggling with mental illness are at much higher risk for experiencing incarceration. They are vastly overrepresented in U.S. prisons in comparison to the country’s mental health hospitals: again, this is intricately connected to the criminalization of poverty, substance abuse, homelessness, over-policing, being a person of color, being LGBTQIA+, and a lack of accessible mental health care. The incarceration system is at odds with the mental health of people struggling with mental health conditions. The available mental health treatment available in prison systems is inconsistent, unreliable, and lacking in quality and quantity.¹⁰ Prisons face understaffing and are simply unequipped to properly treat people and their mental health. Not only are prisoners disproportionately composed of people living with mental health struggles, they only continue to heighten the severity of the mental health struggles of those incarcerated.¹⁰ Punitive disciplinary measures– such as solitary confinement– can only further facilitate the deterioration of a person’s mental health. 

Thus, mental health is a crucial factor to consider when analyzing the full complexities of queerness and the incarceration system. For a breadth of reasons, the LGBTQIA+ community is disproportionately at risk for mental health struggles. According to a 2013 survey, about 40 percent of LGBT adults have experienced rejection from a family member or a close friend.  LGBTQIA+ individuals have to confront homophobia, transphobia, identity-based shame and hate crimes. They face several forms of discrimination and are targets of hate crimes. LGBTQIA+ people have a 120 percent higher chance of experiencing homelessness.  These are all experiences that can most certainly attribute to a deterioration in mental health and overall well-being for queer individuals. LGB adults are more than twice as likely than heterosexual adults to experience mental health struggles, such as depression and anxiety.¹¹ Transgender individuals are four times as likely as cisgender people to experience a mental health condition.¹¹ They are also twice as likely to experience depression, contemplate suicide, and attempt suicide.¹¹ Forty percent of transgender adults have attempted suicide in their lifetime, while less than 5 percent of the general U.S. population has.¹¹ Additionally, the LGBTQIA+ community faces many barriers to receiving proper mental health care treatment. Especially when considering other compounding factors like race and economic status, the quality of care that LGBTQIA+ community members receive is far from adequate.¹¹ Because the incarceration system targets people who have mental illness, understanding the relationship between mental health and the well-being of queer communities is crucial in analyzing the oppressive nature of carceral systems against queer communities. 

Queer, trans, and gender non-conforming communities have faced continued ruthless violence and harm from policing, the incarceration system, and other systems of violence that are interconnected to them. In November of 2022, the LGBTQIA+ community was targeted in a massive shooting at Club Q in Colorado Springs on the eve of Trans Day of Remembrance. The incarceration system is just one link of an entire system that has oppressed and afflicted violence against LGBTQIA+ communities, especially those of color. The incarceration system ever has, and its current state never will, protect the LGBTQI+ community. A challenge when addressing the impacts of the incarceration system is the overwhelming number of interconnected struggles that underpin most, if not all, the health inequities visible in different populations who are incarcerated. One cannot properly have a discussion about the harm inflicted by the LGBTQIA+ community without discussing the violence that the incarceration system perpetuates amongst those who are poor, people of color, disabled, those struggling with mental illness, or those who fall into more than just one of these categories. Carceral systems cannot keep us safe. Punitive measures and locking people up fail to provide proper mental health treatment, affordable housing, living wage jobs, or increase our safety. The incarceration system is a system of intolerable violence that continues to maintain hegemony at the expense of communities that have always been systematically targeted by the state. 

 Struggles against oppression are directly connected to the health and well-being of all people. To be a health advocate is to also advocate against racism, patriarchy, transphobia, homophobia, ableism, etc. Our incarceration system is oppressive and an extension of systemic violence within our society. What more evidence will it take to persuade the public of the inherent violence of the prison-industrial complex in the United States? Abolition practices and activism pushes us to consider how we can foster cultures of resistance where safety and community is built in struggle as opposed to relying on the state. The causes for the higher rates of mental health crises, higher rates of incarceration, higher rates of homelessness, and the criminalization of LGBTQ+ communities are all one and the same. I would argue that the hyperincarceration of trans and queer folks, especially those of color, are not symptoms of a broken system. Rather, I would argue that these are the direct outcomes of a system that is functioning the way it was created to. The construction of systems and culture that criminalize queerness is deliberately fabricated and is dependent on racism, patriarchy, classism, and transmisogyny to continue to perpetuate these cycles of violence. A system that has historically and repeatedly functioned to criminalize queerness, mental health struggles, poverty, and being a person of color is a system that cannot be reformed. The incarceration system inflicts intolerable and violent injustices against people of color, queer, low-income, and vulnerable communities. 

This community– our community– protects each other. If we want to advocate for the safety, health, and well-being of the Queer community and other marginalized groups, we must seek to dismantle the prison-industrial complex. Healthcare cannot be apolitical. Liberation cannot be achieved without abolition. Seeking liberation, which necessitates health equity for all people, demands critical reimagining of what is possible and thinking expansively about alternative modes of existing, being, and living freely without state-sanctioned violence.

 

References

1. Diamond A. I’m a Trans Woman Locked in a Men’s Prison. I’m Fighting to Be Free. In. Them. Vol 2023: Them; 2021.
2. Jae Sevelius VJ. Challenges and opportunities for gender-affirming healthcare for transgender women in prison. Int J Prison Health. 2017;13:32-40.
3. Transgender People Incarerated in Crisis.  https://legacy.lambdalegal.org/know-your-rights/article/trans-incarcerated-people. Accessed December 3, 2023.
4. Diaz J. Trans Inmates Need Access to Gender-Affirming Care. Often They Have to Sue to Get It. In. NPR2022.
5. Manson J. Transgender Women of Color Face Crushing Rates of Incareration, Solitary Confinement, and Abuse. 2019; https://solitarywatch.org/2019/07/22/transgender-women-of-color-face-crushing-rates-of-incarceration-solitary-confinement-and-abuse/. Accessed July 19, 2019.
6. Herring T. The Research Is Clear: Solitary Confinement Causes Long-Lasting Harm. 2020; https://www.prisonpolicy.org/blog/2020/12/08/solitary_symposium/. Accessed December 8, 2020.
7. Congress TLo. LGBTQIA+ Studies: A Resource Guide 1969: The Stonewall Uprising https://guides.loc.gov/lgbtq-studies/stonewall-era. Accessed December 3, 2023.
8. Strangio C. “HIV Is Not a Crime. In. ACLU2019.
9. Griffith D. LGBTQ Youth Are at Great Risk for Homelessness and Incareration. 2022; https://www.prisonpolicy.org/blog/2019/01/22/lgbtq_youth/, November 23.
10. Prisons No Place For the Mentally Ill. The San Diego Union-Tribune. February 12, 2004.
11. LGBTQI. 2022; https://www.nami.org/Your-Journey/Identity-and-Cultural-Dimensions/LGBTQI. Accessed December 18.
12. National Center For Transgender Equality. Prison or Detention Reform. National Center For Transgender Equality. Accessed February 11, 2024. https://transequality.org/sites/default/files/docs/resources/NCTE_Blueprint_for_Equality2012_Prison_Reform.pdf