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Although Catalonia has an integrated model where prison healthcare depends on the public health system, daily reality shows deep cracks between policy and practice. Our study, which involved eight transgender women, has given voice to the participants, who describe healthcare as an often hostile or indifferent terrain, navigating vulnerability in healthcare dynamics. Inmates report frequent episodes of insensitivity, where misgendering or professional lack of knowledge about gender diversity generate mistrust and erect barriers to dignified care.

This vulnerability is compounded by a constant quest for well-being amidst uncertainty. Our study documents the anguish caused by the discontinuity of gender-affirming treatments; the fear of not receiving hormones or losing achieved physical changes is not experienced as a simple medical formality, but as a direct attack on their identity. Furthermore, inmates report a critical lack of mental health support that is truly empathetic and not limited to drug prescription, a care gap that increases the risk of psychological distress and suicidal ideation.

Finally, our research exposes how prison replicates and intensifies past violence, negotiating a landscape of violence. With life stories often marked by family abuse and social exclusion, many find a new form of institutional violence within the walls: isolation. Often justified by the administration as a "protection" measure against potential aggression, confinement in separate cells or specific units is perceived by transgender women as an additional punishment that limits their socialization and further stigmatizes them.

These findings underscore the urgency of transcending the current model. Inclusive laws are not enough; it is necessary to train staff in cultural competence and create specific protocols that guarantee continuity of care and avoid segregation. From the Nursing Department at the UAB, we advocate that prison health must be a space for human rights, where the dignity of all people is recognized and respected, beyond the walls that separate them from society.