Chelsea Manning: Trans Behind Bars

Pvt. Bradley Manning made waves when he released the largest number of classified documents in American history to Wikileaks.

Then, after being sentenced to 35 years in prison, she captured everyone's attention again after coming out as a transgender woman. Introducing herself as Chelsea Manning, she is fighting for her request to receive hormone therapy while incarcerated - an ongoing battle for transgender prisoners across the country.

"We want to make sure that transgender prisoners have access to the appropriate medical care that they are entitled to, and there are too many systems that are not providing that care or are not knowledgeable about what that care should be," said Amy Whelan, a senior staff attorney with the National Center for Lesbian Rights.

By estimation, transgender prisoners represent a very small percentage of the federal prison population and an official record is not available. However, in the last 2005 census of prisons 1 percent of prisoners' genders was not identified. The Florida Department of Corrections said there are only seven in the Sunshine State.

No matter the number, the battle for fair medical treatment and protection from sexual assault is ongoing. Prisoners are entitled to medically necessary treatment and medication, treating anything from schizophrenia to diabetes, with some citing the Eighth Amendment as proof. Some, however, don't feel that gender dysphoria or gender identity disorder (GID) is one of them.

"All prisoners are entitled to receive treatment that's medically necessary, and this is treatment that's medically necessary, so I don't feel like it's special treatment. Just like a diabetic should receive the treatment that he requires to treat his disorder, so should someone receive it for gender identity disorder," said Cassandra Capobianco, an attorney with Florida Institutional Legal Services (FILS).

Vanessa Adams was a transgender woman who had not transitioned and was diagnosed with GID by doctors at a prison in Missouri in 2005. She made at least 19 requests to be given hormone replacement therapy, all of which were denied because she was not undergoing therapy before she was incarcerated - called a "freeze frame." Adams attempted suicide multiple times and attempted to cut off her penis and testicles with a razor, causing her to be moved to multiple prisons across the country.

"No one knows what it is like to be in the wrong body," she told a staff member who found her standing in a pool of blood.

While continuing her sentence at FFC Coleman in Florida, she finally managed to remove her penis.

"[Prisoners] are at the mercy of correctional physicians and staff to provide them with care, and when that care is not forthcoming, some prisoners with severe gender dysphoria become so desperate that they take these actions," Whelan said.

Adams was sent for treatment in Massachusetts, where she continued her sentence. In 2009, she was represented by FILS and the National Center for Lesbian Rights and other groups and finally in 2011, the Bureau of Prisons dropped its freeze frame rules regarding hormone therapy. Now, each prisoner is evaluated individually.

Plus, estrogen and testosterone is not something prison pharmacies would have a problem getting their hands on.

"[Hormones are] really the only effective treatment for GID," Capobianco said. "They prescribe hormones to other people with other disorders, including to sex offenders in the Bureau of Prisons... it is certainly something they can get and we know that because they prescribe it to people who had a prescription coming in, and they eventually prescribed it for Miss Adams."

Another battle facing transgender prisoners is where they are housed. In Florida, prisoners are placed according to their physical gender, which is problematic to those who have not transitioned.

Non-heterosexual inmates are more likely to be assaulted in prison, but the dangers within prison walls is especially high for those who are transgender. In a study conducted of California prisons by the by the University of California Irvine in 2007, 59 percent reported being sexually assaulted while only 4 percent of randomly selected straight inmates could say the same. In the same study, 41.2 percent of transgender prisoners said what happened to them was rape - compared to 2.2 percent for straight inmates.

Also, 70 percent of officers said they were not aware of the assaults against transgender inmates. Even worse, 64 percent of transgender victims who required medical treatment after the assault said they did not receive it.

Changes are being seen slowly across the country, though. At least four jails or prisons in Cook County in Illinois, Cumberland County in Maine, Washington, D.C. and Denver, Col. have extra provisions in place to accommodate transgender prisoners as much as they are entitled to.

"My hope is that prison systems will move toward treating gender identity disorder the same way that they treat schizophrenia or heart disease or any other disorder," Capobianco said. "All prison systems should be providing evaluations and treatment for all of their transgender inmates regardless of what treatment the person received prior to incarceration or really any other factor. If they need it, then they should get it."