90 Towards the Effective Protection of LGBTI Persons Deprived of Liberty health consequences ensue”73. In order to avoid discriminatory attitudes, assumptions based on stereotypes, and misconceptions about the needs of trans persons, prison staff, and in particular healthcare staff, should be appropriately trained on gender identity and sexual orientation. It is crucial that prison staff (and monitoring bodies) understand that trans detainees are not per se sick and that the specific healthcare they require does not constitute a form of special treatment or “unnecessary luxury”, but a human right that must be made available. In cases where trans detainees began hormone therapies outside prison, it is essential that the treatment not be discontinued upon entry into prison or upon transfer to another facility. In addition to being given access to hormones, trans detainees should be under the supervision of appropriately trained medical staff, who have the ability to address potential medical side-effects of hormone therapy. Detainees who have undergone surgical modification of their bodies likewise should have access to adequate care. The interruption of such treatment often has devastating consequences, including rapid transformations of the person’s body. Detainees who are denied their treatment may resort to self-intervention, self-mutilation, or the use of hormones not adapted for human consumption, which can all have harmful and long-lasting consequences. The principle of equivalence of care should also apply to hormone therapy and gender-reassignment treatment, including surgery. In other words, the support and treatment provided to detainees should mirror that which would be available to them if they were living in a non-institutional setting within the community. Detainees who wish to start transitioning while in detention should not be prevented from doing so. Nevertheless, many States employ a so-called “freeze-framing” approach, whereby trans persons are not permitted to initiate or continue pursuing treatment initiated prior to incarceration. Mental health professionals working with detainees may also be pressured by prison authorities to not recommend surgery, in order to avoid additional costs and burdens. If the ex- Ninth annual report of the Subcommittee on Prevention of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, CAT/C/57/4 22 March 2016, Para. 65. 73