The health and wellbeing of incarcerated trans, gender diverse, and non-binary people: An international scoping review.

A total of 57 articles were included in the scoping review after screening eight academic databases and grey literature.

• Databases were searched in May 2024 and again in June 2025.
• The review followed Arksey and O'Malley's (2005) five-stage iterative process and PRISMA-ScR guidelines.
• Articles published in all languages were considered.
• Grey literature was included alongside academic databases.

Incarcerated trans, gender diverse, and non-binary people consistently face restricted access to gender-affirming healthcare.

• Restricted access to gender-affirming healthcare was identified as one of four major thematic categories.
• This finding was described as 'consistent evidence' across the international literature reviewed.
• The review categorized this under the theme of 'general and gender-affirming healthcare.'

Incarcerated trans, gender diverse, and non-binary people experience systemic mental health challenges.

• Mental health and wellbeing was identified as one of the four major thematic categories in the review.
• The evidence on mental health challenges was described as 'consistent' across the included studies.
• Mental health challenges were framed as 'systemic' rather than individual in nature.

Incarcerated trans, gender diverse, and non-binary people are exposed to high levels of violence.

• Violence was identified as a distinct thematic category among the four major themes.
• Exposure to violence was described as part of 'consistent evidence' across the international literature.
• Violence was treated as a separate thematic domain from mental health and healthcare access.

Incarcerated trans, gender diverse, and non-binary people face sexual health risks and HIV care gaps.

• Sexual health and infectious disease was identified as one of the four major thematic categories.
• HIV care gaps were specifically highlighted as part of the consistent evidence.
• Sexual health risks were documented alongside broader infectious disease concerns.

Trans, gender diverse, and non-binary people in prison demonstrate creativity and resilience in response to gender-affirming attire and grooming restrictions.

• Gender embodiment was identified as one of the four major thematic categories.
• Restrictions on gender-affirming attire and grooming were documented across the included studies.
• Despite these restrictions, creativity and resilience were identified as consistent responses among this population.

The review identified significant geographic, thematic, methodological, and subpopulation knowledge gaps in the existing literature.

• Knowledge gaps were identified across four dimensions: geographic, thematic, methodological, and subpopulation.
• The review covered international literature, suggesting the gaps are global in nature.
• These gaps were noted despite the inclusion of 57 articles from multiple countries.

The review concludes that policies and interventions must be evidence-based, integrated, culturally responsive, sustainably resourced, and involve community experts and incarcerated people in their design and evaluation.

• Findings highlight 'the need for clear and consistently implemented prison policies and prison diversion strategies.'
• Policies must be developed 'in the face of populist discourse.'
• Community experts and incarcerated people are specifically identified as necessary participants in policy design and evaluation.