A Monitoring Guide 87 Initial medical and psychological screenings upon admission are essential to identify and properly address the healthcare needs of all detainees, and in particular those with special medical needs. The Nelson Mandela Rules’ requirement that the information entered in prisoner file management systems shall enable the determination of a detainee’s “unique identity, respecting his or her self-perceived gender” (Rule 7(a)) should be understood as ensuring that the special needs of trans detainees are taken into consideration from the outset of their detention. LGBTI detainees, and in particular trans detainees, often have special medical needs, including due to a higher incidence of comorbidity and past trauma. Prison healthcare should provide mental health counselling, which is particularly important for LGBTI detainees who have experienced sexual violence and other forms of abuse and trauma. Evidence suggests that LGBTI detainees may have heightened needs for mental health support. It is important that initial screenings are conducted in full confidentiality, by qualified health care personnel. Prevention of sexually transmitted diseases and infections In most places, the rate of HIV/AIDS tends to be higher in prisons than in the outside population, especially where a significant percentage of detainees are incarcerated for drug-related offences. Women are reported to face higher risks of entering prison with an STI, including HIV/AIDS. Sexual intercourse among detainees is prohibited in many contexts (or tolerated if it is invisible), but this prohibition does not typically prevent sexual activity from occurring. The concealment of sexual activity furthermore makes it nearly impossible to differentiate consensual from coerced sexual activity. The prevailing taboos surrounding sexuality in prisons not only aggravates the invisibility of victims of sexual violence, but also contributes to the spread of STIs, including HIV/AIDS and hepatitis. Prison dynamics can be conducive to forms of sexual interactions that increase the risk of transmission, in particular when detainees Chapter III available in the community (the principle of equivalence of care). In practice, however, prison health services tend to be inferior or outrightly poor, with the healthcare needs of detainees being regarded as unnecessary luxuries.