PITTSBURGH, Nov. 14, 2018 - Previously incarcerated transgender women can find themselves caught in a cycle that leads to repeat jail time. A new analysis of Allegheny County by University of Pittsburgh Graduate School of Public Health researchers identifies potential solutions that could lead to transgender women being more successfully reintegrated into society.

The findings will be presented today at the American Public Health Association's 2018 Annual Meeting & Expo in San Diego. "Health Equity Now" is the theme of this year's meeting.

"I think we are having a moment right now where the needs of transgender people are more visible," said Stephanie Creasy, M.P.H., project coordinator in Pitt Public Health's Department of Behavioral and Community Health Sciences. "But visibility does not always mean equal rights or improved health and safety. In this study, we've identified barriers that make it more difficult for transgender women to re-enter their communities, as well as the factors that may help these women, and use that information to present potential solutions."

Seven percent of transgender people are incarcerated during their lifetimes, compared with 2.7 percent of the general population. In Pennsylvania, 57 percent of transgender people serve their maximum sentences, compared with 19 percent of the general population. Research has shown that transgender women experience higher rates of adverse childhood events, which have been associated with higher rates of incarceration.

"Transgender women also experience significant discrimination in workplace and health care settings, which often leads to participation in a survival economy that leaves them more susceptible to arrest and incarceration," said Creasy.

As part of her master's thesis work at Pitt Public Health, Creasy performed a mixed-methods analysis that involved in-depth interviews with transgender women living in Allegheny County who had been previously incarcerated for nonviolent crimes, coupled with geospatial mapping of the county's trans-inclusive resources, public transportation, probation offices and mental health services.

The study participants were Allegheny County residents between 29 and 48 years old. Half were HIV-positive, and two-thirds were people of color. Half had been incarcerated more than once. All had been housed with men while incarcerated and all said they feared for their safety due to their transgender identities. Some said they were physically and sexually abused and called "it" or "thing."

Post-release, all participants said they'd experienced discrimination during job interviews, and stigma and harassment from employers and coworkers. They commonly said that transportation to work or probation meetings was difficult. They also had difficulty finding conveniently located health care providers for transgender-specific needs and HIV care when necessary.

When Allegheny County probation offices, trans-inclusive health care providers and job services were mapped with bus lines and overlaid on a map detailing the areas of the county with higher rates of poverty (where transgender people and previously incarcerated people are more likely to live), Creasy found that the resources didn't align with the areas of need.

She also asked the participants about experiences that they found helpful. Two-thirds of participants said that having social support, such as being with other transgender women or gay men, gave them a sense of resilience while incarcerated. Participants who connected to social support via friends, family or community post-incarceration said they felt less likely to be re-incarcerated.

"Our study is a good place to start when considering incarceration of transgender women and how to connect them with resources post-release in an effort to lower rates of recidivism," said Creasy. "Co-locating trans-inclusive resources - such as career services, health care that includes hormone therapy and HIV clinics - in places close to public transport is one recommendation."

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Additional authors on this research are Mary E. Hawk, Dr.P.H., Mackey Reuel Friedman, Ph.D., M.P.H., Christina Mair, Ph.D., and James Erin Egan, Ph.D., M.P.H., all of Pitt Public Health, and Jennifer McNaboe, M.P.H., of Beth Israel Deaconess Medical Center.

This research was funded by the Pitt Public Health Center for Health Equity Master's Student Scholarship Award and the Karen S. Peterson Memorial Research Award for Women's Health.

About the University of Pittsburgh Schools of the Health Sciences

The University of Pittsburgh Schools of the Health Sciences include the schools of Medicine, Nursing, Dental Medicine, Pharmacy, Health and Rehabilitation Sciences and the Graduate School of Public Health. The schools serve as the academic partner to the UPMC (University of Pittsburgh Medical Center). Together, their combined mission is to train tomorrow's health care specialists and biomedical scientists, engage in groundbreaking research that will advance understanding of the causes and treatments of disease and participate in the delivery of outstanding patient care. Since 1998, Pitt and its affiliated university faculty have ranked among the top 10 educational institutions in grant support from the National Institutes of Health. For additional information about the Schools of the Health Sciences, please visit http://www. health. pitt. edu .

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