words of Chelsea Manning, the day after she was sentenced to 35 years for leaking classified military documents. (Manning had been arrested, tried and sentenced in a military court as Bradley Manning.)"I am Chelsea Manning. I am a female. Given the way that I feel, and have felt since childhood, I want to begin hormone therapy as soon as possible." These were the
The military responded to Manning's statement with its own: "The Army does not provide hormone therapy or sex-reassignment surgery for gender identity disorder."
Manning likely will serve her sentence at Fort Leavenworth, the only military prison for those sentenced to ten or more years, a military spokesperson told The Associated Press. Fort Leavenworth is a men's military prison in Kansas. As reported in Truthout, chances seem slim that Manning will be able to begin hormone therapy anytime soon. But what else awaits Chelsea Manning as she begins her 35-year sentence as the first openly trans woman at the US Detention Barracks (USDB) at Fort Leavenworth?
Access to Hormones in State and Federal Prisons and the Eighth Amendment
Manning attorney David E. Coombs has publicly stated that he hopes the military "would do the right thing" and provide hormone therapy for Manning. "If Fort Leavenworth does not, then I'm going to do everything in my power to make sure they are forced to do so."
Coombs may be able to draw on legal precedents that have forced the federal and state prison systems to change policies about hormone treatment. After Wisconsin passed a 2005 law barring trans prisoners from receiving hormone therapy or sex reassignment surgery, advocacy groups sued the state on behalf of trans prisoners, some of whom had received hormones for years prior. In 2010, a federal court ruled that denying trans prisoners to hormones and other medical treatment violated the Eighth Amendment. The US Supreme Court affirmed that decision in 2011.
That same year, a settlement agreement forced the Federal Bureau of Prisons, which oversees the federal prison system, to change its policy to allow an individualized assessment, evaluation and treatment of prisoners for "gender identity disorder." Before that, only people who had been diagnosed with "gender identity disorder" previously and were receiving documented hormone treatment were eligible for in-prison hormone therapy.
However, change in policy does not necessarily equal immediate changes in practice. Alisha Williams is the director of the Prison Justice Project at the Sylvia Rivera Law Project (SRLP), which works with incarcerated trans people. According to Williams, until 2008, the New York state prison policy denied hormone therapy to trans prisoners unless they could prove a diagnosis of "gender identity disorder" and prescribed hormone treatment prior to incarceration. Because gender-related hormone prescriptions are not covered by Medicaid or by many private health insurance companies, many trans people rely on less formal avenues and lack a legal prescription. The policy was changed in 2008. "Theoretically, that means you can be diagnosed with 'gender identity disorder' for the first time while in prison and receive hormones, but the reality is that trans people are still having trouble getting treatment," she told Truthout. According to letters received from clients, medical staffs in many prisons continue to make decisions based on the previous policy. "It wasn't until May 2013 that [the state Department of Correctional Services] clarified its policy to state that people can receive diagnosis and treatment for the first time in prison." However, even with the clarified policy, the process for diagnosis and prescribed treatment can take many months.
Manning had been diagnosed with Gender Dysphoria (formerly known as Gender Identity Disorder) by both Dr. David Moulton, the forensic psychiatrist assigned to review Manning's case, and Dr. Michael Worsley, the clinical psychologist Manning saw in Iraq. If Manning were entering a nonmilitary prison, a previous diagnosis might increase the likelihood of receiving hormone therapy, although she might still have to fight for treatment.
The Rev. Jason Lydon has worked with incarcerated trans people nationwide through Black and Pink, a support organization for incarcerated LGBTQ people. He told Truthout about one Black and Pink member, a trans woman who entered the Texas prison system four years earlier with both a "Gender Identity Disorder" diagnosis and a legal prescription for hormones. She was still denied hormone therapy. "She spent years writing letters and collecting documentation that the prison was deliberately withholding treatment. After a four-year fight, she's finally getting her hormones."
If trans people do receive hormone therapy, they may not receive the correct dosage, even when armed with a court order. When CeCe McDonald first arrived at Minnesota's St. Cloud Correctional Facility, prison staff gave her less than one-third of her prescribed 20 milligrams of hormones. It was not until outside supporters flooded the prison with phone calls that the prison began administering the correct dosage.
Military incarceration provides an additional obstacle to hormone access. Aaron Myracle, a former military police soldier, told Truthout that all items sent to a person at Fort Leavenworth need to be bought directly from a vendor on the prison's approved list. "Even if she were willing to pay for her own hormones, she would have to go through an approved vendor. I don't think that any of the approved vendors provide those hormones." If Manning were transferred to a federal prison, she may have a better chance at receiving hormone therapy. "If a discharge were part of your sentence after all your appeals were exhausted, you become eligible for transfer to a federal prison," Myracle explained. However, military regulations do not permit a prisoner to request the transfer; instead, military administrators decide whether to transfer a prisoner.
What Else May Be In Store for the First Openly Trans Woman in a Men's Military Prison?
"Chelsea Manning is the only openly trans woman housed at Leavenworth," Myracle told Truthout. "The USDB doesn't have a policy in place for how to deal with trans people."
According to Myracle, every person who enters Fort Leavenworth initially is housed in Max 1 or the special housing unit. After being processed and tested psychologically and medically, openly gay and bisexual people have been allowed to live in general population or even been assigned to trustee status, enabling them to work on the military base and have limited interactions with the outside military population. Myracle suspects, however, that because of her actions and gender identity, Manning will not be placed in minimum security or be made a trustee.
Coombs has stated that he doesn't fear for Manning's safety in prison. "Everyone that's in a military prison is a first-time offender. These are soldiers who have done something wrong, have gone to prison and are really just trying to do their time and then get out," he told Today News.
In nonmilitary prisons, trans women in male prisons are often at great risk of sexual assault: one study found that 59 percent of transgender women in California's male prisons had been sexually abused while incarcerated, compared with 4 percent of the male-identified population.
In its statement to Today News, the military stated, "The USDB has implemented risk assessment protocols and safety procedures to address high-risk factors identified with the Prison Rape Elimination Act." The media relations office at Fort Leavenworth declined to elaborate on these protocols and procedures when contacted by Truthout.
Joyce Wagner, a member of Iraq Veterans Against the War (IVAW), was not surprised to hear this. "The military didn't have a system for reporting sexual assault until 2008, so it doesn't surprise me that they don't have a policy in their prisons." Wagner, who served from 2004 until 2006, was sexually assaulted on their last day in the Marines. "I had no idea how to report it," they recalled. "I learned more about reporting sexual assault from the outside looking in [working with IVAW] than when I was in the military."
Fifty-seven percent of the people at USDB are confined for sex-related offenses (including incest, pedophilia and rape). According to "Captain Incarcerated," a person currently confined at Fort Leavenworth, "The odds of being raped at the USDB are practically nonexistant." Captain Incarcerated speculates that the high percentage of people confined for sex offenses, especially compared with people in nonmilitary prisons, is "perhaps as a result of the military’s crackdown on such offenses in response to the media spotlight on sexual harassment and assault in war zones."
Lydon said he does not view this high percentage as a factor that would increase the threat of sexual violence against prisoners such as Manning. "In my experience, people convicted of sex-related offenses tend to be model prisoners. They stick to themselves and are more likely to be victimized than victimizers." Myracle agrees, although for different reasons. "Sexual assault is rare in Fort Leavenworth," he stated. He feels that the military's increased sense of discipline and restrictions on movements within the prison help prevent much of the violence found in non-military prisons. In addition, prisoners are wary of jeopardizing their chance at parole. "Parole rates from USDB are very low," he stated. "People don't want to jeopardize their already-slim chances, so they absolutely want to conform to the rules as much as possible."
Do Prison Guards and Staff Members Pose a Threat to Manning's Safety?
According to It's War in Here, the SRLP's report on the treatment of trans and intersex people in men's prisons, trans prisoners' visibility frequently makes them targets for homophobic and transphobic violence. Interviewees reported that much of this violence and brutality comes at the hands of correctional officers and other prison employees.
Williams has heard about numerous instances of viciousness by prison staff members against trans women. "Clients have told me that COs [correctional officers] tell them that they're in a men's facility, that they'll never be women," she recalled. "One woman wrote and said that, when she arrived [at a men's prison], the CO pushed her, told her to 'be a man' and do push-ups. She did until she couldn't do anymore and collapsed. Then the CO started kicking her." She points out that the military prison's emphasis on discipline means there are more rules and more punishments for deviations from these rules. "If Fort Leavenworth is a prison where staff have been trained to think that trans people are sexually deviant, they may try to police Chelsea's gender expression," Williams said. "And, because of her high profile, Chelsea Manning is more likely to be deemed a 'sexual deviant.' "
Myracle said Manning's high visibility and the widespread exposure of past brutality against her may dissuade the staff from abuse. "Having been an MP and been in the military culture, I'd say that USDB staff have probably gotten a lot of training and warning to avoid any potential controversy around Chelsea Manning," he stated. However, as with any prisoner, staff can punish Manning in sanctioned ways - including placement in administrative segregation (a solitary confinement unit). The staff also can force prisoners physically to comply with military grooming standards. Because USDB is a men's prison, Manning will be forced to adhere to male grooming standards. "She'll be issued the same uniform as everyone else, including male undershirts and tighty whities. She won't be allowed to grow her hair. If she refuses to have her hair cut, the US military is more than willing to physically restrain her and cut her hair. Similarly, if they suspect she has unauthorized [feminine] undergarments, they will physically restrain her and remove the suspected clothing from her."
Lydon points out that being coerced into conforming to a gender identity can lead to deleterious mental health effects. "Self-harm, including eating disorders, cutting, smashing their hands, is a big issue for many trans women in prison. The control of pain becomes a way to control their bodies."
At USDB, Manning most likely will encounter people angry at her actions and her open gender identity. Myracle notes that military culture, like the civilian world, runs the gamut of ideas and opinion. "There were people in every unit I served in who were openly gay. But very few people are accepting and understanding of trans people, especially when living in close quarters, either in or out of the military," he recalled. "There were some really horrible incidents in which men who dated trans women were beaten to death by their fellow soldiers." Myracle also noted that queer people still enlisted in the military have "pretty roundly rejected Chelsea Manning. She should not expect to find camaraderie among the gay and bisexual men there. They're angry at her actions and see her [open trans identity, especially in this context] as an embarrassment."
So What Now?
"A lot of the reaction over Chelsea Manning identifying as Chelsea plays out a tactic of redirecting attention to her actions and identity instead of looking at the nature of actions that are criminalized," Alisha Williams told Truthout. She compares this redirection with the criminalizing of actions that lead trans people to prison while ignoring the legally sanctioned marginalization and exclusion from legal employment and social safety nets. "Instead of looking at the cycle of poverty and social conditions, the conversation focuses on 'Why don't trans people not commit crimes?' This conversation is not about national security and what's been happening in our military, but focuses instead on an individual's actions."
"In the military, you are duty-bound to expose any knowledge of war crimes," Myracle said. "If you have knowledge and you refuse to expose that, you are now complicit in those war crimes. You are taught that within the first nine weeks of enlisting."
Whether Manning was duty-bound to expose this information, the fact remains that Manning will be spending the next several years in USDB. So what now? "We definitely need to be taking the lead from her," said Wagner who, as a member of IVAW, has supported people incarcerated in military prisons. "She's still going to have a chain of command and all of the military-structured hierarchy. She already faced extreme torture and humiliation, which was sanctioned, although that was stopped because of media attention and outside pressure."