Inmates with gender identity disorders (GID) pose special challenges to policy makers in U.S. prison systems. Transgender persons are likely overrepresented in prisons; a reasonable estimate is that at least 750 transgender prisoners were in custody in 2007. Using the Freedom of Information Act, requests were mailed to each state, the District of Columbia, and the Federal Bureau of Prisons in 2007. The requests were for copies of policies, directives, memos, or other documents concerning placement and health care access of transgender inmates. By April 2008, 46 responses were received; 6 states did not reply. Information was qualitatively analyzed and summarized. There was substantial disparity in transgender health care for inmates with GID or related conditions. Most systems allowed for diagnostic evaluations. There was wide variability in access to cross-sex hormones, with some allowing for continuation of treatment and others allowing for both continuation and de novo initiation of treatment. There was uniformity in denial of surgical treatments for GID.

This thesis presents an ethnographic study of the experiences of men living with and dying from serious illness in prison, with a particular focus on the kinds of care they receive and the ways in which they experience that care. The dissertation draws on extensive ethnographic fieldwork conducted over two years in U.S. state prisons in Maine, presented in three standalone papers. The first paper outlines how the prison and its health care system shape the illness experiences of older and ageing prisoners and asks, what does it mean when the lives of prisoners collide with contracted for-profit medical care and how might their lives be constituted as unworthy of care? The stakes lie in applied policy and practical solutions for custodial services. The second paper explores the experience of caring and being cared for in the context of a prison hospice program, in which incarcerated men provide care to peers who are ill or dying. Through tracing one man’s end of life journey, this chapter considers how hospice caring makes and remakes death and life in prison, and the ways in which this “nefarious” form of escape from disciplinary power translates in the repressive penal regime. The final paper has its roots in sensory ethnography and the emerging field of sensory penality. This is a reflexive piece in which I probe my sensorial subjectivity and particularly touch as a medium of inquiry to explore the sensations of life, death, and dis/connection experienced in a prison infirmary. The observed feel of life and death illuminates new ways of understanding care in custody as a space of simultaneous brutality, beauty, indignity and intimacy. Taken together, the papers shed light on constellations of care in prison, the contingency of relations and personhood, and points of friction between care and custody. / Dissertation / Doctor of Philosophy (PhD) / At a time when the prison population is rapidly ageing and more people than ever are dying in custody, this thesis explores what it is like to experience serious or terminal illness in prison, the kinds of care prisoners receive and how they experience that care. Based on ethnographic fieldwork in U.S. state prisons, three themes are examined: 1) how the prison and its privatized health care system shape the illness experiences of older prisoners; 2) how prisoners mediate the experience of dying in prison through a peer- based prison hospice program; and 3) how the senses and especially touch elicit new ways of knowing and understanding end of life in prison. Taken together, the three papers shed light on forms of care in prison, the mutability of relations and life, and points of friction between care and custody.

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No. of bitstreams: 1 ELIANA OLIVEIRA PEDREIRA LIMA.pdf: 820097 bytes, checksum: fc27bd7fdbcf9e6a0cad1aed0f04add4 (MD5) Previous issue date: 2013-06-05 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Understand how to process the relations in everyday life of prison and evaluate the situation of health care in the detainee CDP São Vicente/SP was the main objective of this study aimed to ascertain the specific living conditions of detainees in the town of São Vicente/SP; see how they detect diseases before and during incarceration in the town of São Vicente/SP; know the actions taken by health professionals and ways to treat diseases of the detainees; identify which inmates' complaints of CDP São Vicente/SP in relation to health care of the detainee. This is qualitative research conducted in Provisional Detention Center Dr. Luis Cesar Lacerda de São Vicente, São Paulo, and ten prisoners as subjects and a health care professional who works in the prison unit. With detainees, the instrument used was a semi-structured interview and the professional, open interview with script. Data collection occurred during the months from July to December 2011. The results revealed that the profile of inmates does not differ from that found in other studies. Of the ten inmates, four are in the range of 20 to 30 and the remaining six between 31 and 40 years. The low education level was confirmed, as two did not complete primary school and eight complete elementary school. Regarding marital status, three singles and seven are married. Regarding the number of children, three prisoners have no son, four even has two sons, two of three to four children and only one inmate have five or more children. The color self-declared also confirmed, with browns and blacks add nine prisoners and one white. Seven inmates are from Baixada Santista and three from other cities in the state of São Paulo. Seven primary and three are repeat offenders, and still, eight and two regularly receive visits any visit. A professional is female, 50 years old and worked for nine years and six months in SAP, throughout this period in the town of São Vicente. The analysis of data was based on two main themes: life in prison and the inmate health care. The everyday prison is marked by idleness, power relationships and coping strategies. In health care the inmate was found that prisoners are assisted minimally, because there is a shortage of health professionals, such as doctors and nurses, and the distribution of drugs is only regulate when it comes to TB, HIV and mental illness. In other cases, there is delay in treatment and medication from the prison unit and are usually family members who bring drugs. With regard to food, this is general dissatisfaction, although it is an important component to maintaining health. The research sought to show a clip from the reality experienced by prisoners regarding health care in the town of São Vicente. / Compreender como se processam as relações na vida cotidiana do cárcere e avaliar a situação da atenção à saúde do detento no CDP de São Vicente/SP foi o principal objetivo desse estudo que teve como objetivos específicos conhecer as condições de vida dos detentos no CDP de São Vicente/SP; verificar como se detectam as doenças antes e durante o processo do encarceramento no CDP de São Vicente/SP; conhecer as ações desenvolvidas pelos profissionais de saúde e formas de tratamento das doenças dos detentos; Identificar quais as queixas dos detentos do CDP de São Vicente/SP em relação à atenção à saúde do detento. Trata-se de pesquisa qualitativa realizada no Centro de Detenção Provisória Dr. Luiz Cesar Lacerda de São Vicente, São Paulo, tendo como sujeitos dez presos e uma profissional da área da saúde que atua na unidade prisional. Com os detentos e com a profissional de saúde, o instrumento utilizado foi a entrevista semiestruturada. A coleta de dados ocorreu durante os meses de julho a dezembro de 2011. Os resultados revelaram que o perfil dos detentos não difere do encontrado em outros estudos. Dos dez detentos, quatro estão na faixa dos 20 aos 30 e os seis restantes entre 31 e 40 anos. A baixa escolaridade foi confirmada, pois dois não concluíram o ensino fundamental e oito completaram o ensino fundamental. Quanto ao estado civil, três são solteiros e sete casados. No que diz respeito ao número de filhos, três presos não tem filho, quatro tem até dois filhos, dois de três a quatro filhos e apenas um detento têm cinco ou mais filhos. A cor auto-declarada também se confirmou, sendo que pardos e negros somam nove presos e apenas um branco. Sete detentos são da Baixada Santista e três oriundos de outras cidades do Estado de São Paulo. Sete são reincidentes e três primários, e ainda, oito recebem visitas regularmente e dois nenhum tipo de visita. A profissional é do gênero feminino, 50 anos de idade e, trabalha há nove anos e seis meses na SAP, todo esse período no CDP de São Vicente. A análise dos dados se deu a partir de dois eixos temáticos: a vida no cárcere e atenção à saúde do detento. O cotidiano prisional é marcado pela ociosidade, relações de poder e estratégias de sobrevivência. Na atenção à saúde do detento foi constatado que os presos são minimamente assistidos, pois há falta de profissionais de saúde, como, médico e enfermeiro e, a distribuição de medicamentos só é regular quando se refere à Tuberculose, doenças mentais e HIV. Nos demais casos, há demora no atendimento e medicação por parte da unidade prisional e geralmente são os familiares que trazem os medicamentos. No tocante à alimentação, essa constitui insatisfação geral, embora seja um componente importante para a manutenção da saúde. A pesquisa buscou evidenciar um recorte da realidade vivida pelos presos quanto à atenção à saúde no CDP de São Vicente.