Background : Migrating to the United States (U.S.) for populations whose gender identity is criminalized and/or punishable by death in their country of origin offers a promising future. In the U.S., nearly 267,000 undocumented immigrants identify as LGBT of which 15,000-50,000 are individuals of trans-experience. The burden of marginalization among communities of trans-experience has been well established and recent evidence among those undocumented demonstrates pronounced magnitude. Undocumented communities of trans-experience require efforts to understand the evolution of immigration policy, limitations and precarious implications given the current political climate. Yet, the impact of immigration policy, specifically as it pertains to detention, on adverse health outcomes among individuals of trans-experience remains largely unexplored.
Methods : Applying a poststructuralist framework, which postulates that policy may actually produce the problems it intended to rectify, a critical analysis of immigration detention policy was conducted. The impact of policy on health outcomes among communities of trans-experience was examined from a historical perspective through use of the Transgender Care Memorandum published by U.S. Immigration and Customs Enforcement (ICE) in June 2015 as the predictive unit of analysis.
Results : A historical review confirmed a lack of inclusion and implementation of suitable guidelines safeguarding the rights and well-being of communities of trans-experience while detained. As it pertains to the Transgender Care Memorandum, four domains (sexual assault, abuse, solitary confinement and where policy contributes to the exacerbation of adverse outcomes were noted. Specifically, disproportionate rates of sexual assault, excessive maltreatment and abuse, chronic placement in solitary confinement and subpar care while in detention present long-term ramifications linked to mental health challenges including post-traumatic stress disorder (PTSD) and suicide, preventable illness complications in addition to post-detention treatment-related expenses.
Conclusions : The current immigration policy falls short in supporting undocumented communities of trans-experience. These limitations reinforce dangers that initiated the effort, hope and motivation associated with fleeing oppression, criminalization, or even death. Given the ever-changing climate and recent political attacks on trans-rights, the development of scientifically grounded guidelines through interdisciplinary collaboration including individuals with lived experiences, advocates, law, health, and mental health professionals is urgently needed.