A Stakeholder Analysis of the Current Lebanese Context for Transgender Healthcare: The Perspectives of Non-Governmental Organizations

A Stakeholder Analysis of the Current Lebanese Context for Transgender Healthcare: The Perspectives of Non-Governmental Organizations

Kate Wright, Brandon Peplinski, MPH, Sarah Abboud, PhD, and Omar Harfouch, MD, MPH

Lebanese Medical Association for Sexual Health

Johns Hopkins Bloomberg School of Public Health

Executive Summary

Currently there is little knowledge on the state of transgender health in Lebanon. In this stakeholder analysis, four non-governmental organizations (NGOs) representatives that work with the transgender population were interviewed to better understand the Lebanese context for transgender healthcare. NGOs emphasized that discrimination and abuse are highly prevalent towards transgender people, including persecution by law enforcement, which often limits education, employment, and housing. Access to healthcare is limited by a lack of insurance for transgender services, discrimination by healthcare providers, insufficient knowledge among providers to appropriately communicate with and treat these individuals, and a general lack of competent providers for transgender needs. NGOs agreed that advancing provider education on transgender health issues is vital for improving the health of the transgender population. Although transgender individuals have access to some medical care, legal aid, psychological support, and community support through local NGOs, health services are not comprehensive, and there is generally little awareness in the community regarding the available services and support. This analysis emphasizes the need for next steps in education and training, awareness and communication, and advocacy. Information on current available resources should be better disseminated to the transgender population and health professionals.

A robust transgender health curricula should be implemented in the healthcare provider training process, and trans-friendly providers and NGOs should emphasize networking and collaboration. Communication campaigns may help shift societal perceptions on transgender persons. Further research should be done to direct advocacy, communication, and health program work. Our findings were consistent with previous research on discrimination towards transgender people in Lebanon, and future work should examine these questions from the perspective of transgender people to better elucidate their needs and input.

Introduction

Transgender individuals experience stigma and discrimination globally with few sanctities of safety.1 Although Lebanon does not legally condemn transgender identities—indeed the country can provide protection from arrest with a diagnosis of gender dysphoria2—the current situation does not invoke ease for transgender individuals living there. Family and societal rejection permeates the culture with abuse and discrimination common occurrences.3, 4 A vast majority of the general population considers dressing like the opposite gender as perverted and changing gender identities through surgical procedures as immoral.5 Discriminatory treatment of transgender people can lead to reduced opportunity for education and employment opportunities,3, 4 as well as increased risk for negative mental and physical health outcomes, including depression, suicidal behaviors, and HIV/AIDS.3, 4, 6

Regardless of the legal landscape, transgender individuals continue to suffer at the hands of Lebanese law enforcement through arrest and torture, using Article 534 of the Lebanese Penal Code among morality laws as justification.5, 7, 8 Additionally, an individual is compelled to undergo sexual reassignment procedures in order to change identification papers, solidifying the binary gender requirement and ostracizing those who are gender nonconforming.5, 9, 10 That being said, a transgender identity is typically considered a medical or psychological concern, resulting in some sympathy for transgender individuals from society. Many people believe that they need help rather than punishment and do not condone the use of violence or abuse against them.5

Legal progress has been made in more recent years with a seeming shift in perspective, although severe abuses against transgender people continue to occur. In September of 2015, the Court of Appeals of Beirut ruled in favor of a transgender man regarding his fundamental right to legally change his gender marker to male, including his right to treatment and privacy.11, 12 Contrary to this development, in 2013, a transgender woman and two homosexual men were arrested and verbally and sexually abused. The transgender woman was stripped naked and photographs were taken of her and subsequently distributed to the media.8, 13 Progress is certainly occurring, but there is still work to be done.

To date, there is little knowledge surrounding transgender health in Lebanon and basically no understanding of provision or coverage of transgender-specific services. In this stakeholder analysis project, local non-governmental organizations (NGOs) that work with the transgender population were interviewed to better understand their perspectives on the current context for transgender healthcare in Lebanon

Methods

A stakeholder analysis of the current context for transgender healthcare in Lebanon was performed, targeting NGOs working in transgender health. Stakeholders were recruited using purposive sampling and were contacted based on the sample of NGOs that focus on transgender issues in Lebanon.

A Lebanon-based employee of the Lebanese Medical Association for Sexual Health (LebMASH) conducted the NGO representative interviews. Interview questions were open-ended and included the following topics: NGO provision of services; community response to services; community perceptions of transgender individuals; availability and cost of healthcare providers and services specific to transgender healthcare; access to health insurance; obstacles to obtaining healthcare; and recommendations for improving provider education. All stakeholders gave informed verbal consent to be interviewed and quoted anonymously. De-identified interview responses were compiled for each interviewee, and a summarization was performed, including major themes, agreements, and disagreements in the responses.

Results

Four NGO representatives in Lebanon responded to the inquiry. Each organization provides different services to the transgender community, including advocacy, psychosocial health, medical care, social and legal services, and knowledge production. Table 1 provides a summary of these services. The interviews resulted in a number of themes related to the current situation for the transgender population in Lebanon that we present in the following sections.

Discrimination and Stigma

“The ‘masculine’ gay men regard trans women as having a bad reputation on the gay community because of them. The community does not stand together unfortunately.”
“We’ve seen people who have been kicked out of their houses, didn’t attend school or college, were forced to live in the streets…they had to do sex work.”  

All four NGO representatives emphasized discrimination and stigma as a prevalent and persistent reality for the transgender population. Throughout the interviews, they listed a number of different groups—including law enforcement, healthcare providers, community members, and family—who subject transgender people to physical and emotional abuse, rejection, and marginalization in response to their gender identity. All NGO representatives addressed the problem of job scarcity for transgender people because of their gender identity, resulting in many of them turning to survival sex work, putting them in danger of arrest and sexual assault from law enforcement. At points, the discussions turned to the general lack of information about transgender people within Lebanese communities, and all four representatives agreed that family rejection in particular is common. One representative brought up the concern that even the LGB community discriminates against the transgender population specifically. This pervasive culture of discrimination contributes to the mental health risk that transgender people experience, as noted by all four NGO representatives.

Medical Atmosphere

“When it comes to hormonal therapy, we only have one doctor we refer to. There was another person we tried to engage with, and he refused. There is resistance among healthcare providers.”  

In addition to Lebanese society’s norms and perceptions of the LGBT community, the medical atmosphere presents difficulties for the transgender population. All NGO representatives concurred that insurance companies across the board do not cover transgender-specific health services, so any treatment must be paid for out-of-pocket. Because many transgender people struggle to find employment, paying for healthcare is often impossible. According to all representatives interviewed, this population struggles severely with access to care in general. Some healthcare providers turn transgender individuals away, refusing to treat them. One representative noted that many transgender people avoid accessing care due to a fear of breach of confidentiality, rejection, or humiliation. As a result, many transgender people do not seek or receive medical care at all.

“This is a big risk for transgender persons because they will start hormone therapies for themselves, there will be complications, they will have to stop it, they start to have the features of the opposite sex, then they go back to zero.”

In addition, most healthcare providers lack the knowledge necessary to appropriately communicate with and treat these individuals in a way that is suitable to their specific needs. One representative noted: “There are people who might be willing, but they are not experienced so this is another challenge.” There is also a lack of providers available for specific transgender needs, such as speech/voice therapy, hormonal therapy, gender-affirming surgery, and mental health services catered to the transgender experience. Three representatives discussed the difficulties and dangers transgender people face regarding hormonal medication due to a lack of knowledge regarding the process

for safe hormone use alongside the likelihood of inconsistent financial means.

Gender Dysphoria

“If I get arrested by the police…I give them the ID and I give them the report for gender dysphoria, they back off because a doctor said they have a medical condition and here in Lebanon we regard doctors very highly.” 

Two out of the four NGO representatives addressed the psychiatric diagnosis of gender dysphoria and its effect within the transgender community in Lebanon. In some ways, this diagnosis aids them. Although it does not protect against societal or family rejection, it does provide protection from arrest because Lebanese law recognizes the condition as a mental health concern. Avoiding legal discrimination offers invaluable security, physically and mentally, to this population. A diagnosis of gender dysphoria is also the first step to changing identification documents, a process that is lengthy but not impossible in Lebanon. Even Islam accepts gender dysphoria as a medical condition, according to one key informant.

“When someone doesn’t know about something they’ll keep fearing it, they’ll keep not knowing how to deal with it.”

Improving provider education. All four NGO representatives agreed that advancing provider education in Lebanon is vital for improving the health of the transgender population and for reducing stigma within the medical community. A variety of recommendations arose for promoting education. Two representatives mentioned the importance of including transgender health as part of the curriculum for health professional students. One representative felt that both students and professionals should receive three levels of curricular education. First, a focus on respect presents a base for future knowledge: “I think the education under the respect of a human being, their freedom, that their right to be themselves in their body, in their appearance, etcetera, so when you understand this, I think automatically your behavior and your services will follow.” Second, curricula should include details about healthcare needs and risks specific to the transgender population. Finally, a focus on the role that society plays, particularly regarding mental health, can encourage understanding and promote a shift away from discrimination within this section of the community in Lebanon. This representative also mentioned the significance of health care providers accepting a transgender identity as normal, especially as an effort to advance mental wellness, because the questionn—“Am I normal?”—arises often with transgender individuals.

Another representative had three main recommendations for improving provider education. First, keeping providers involved in the learning process will offer a welcoming and appropriate setting for education. Asking them what they already know about the needs of the transgender population as well as how transgender individuals are currently treated in their practice can encourage reflection within the providers. By starting with what they already know, educators can shift their knowledge base towards what they need to know for proper and just treatment. Second, this representative recommended starting broad and then moving to specifics to encourage a more open and welcoming attitude from the providers. Finally, a strong emphasis was placed on the importance of a thoughtful approach in an effort to avoid turning people away or creating an uncomfortable situation.

“If I’m a health care provider…and I get a patient, it’s my duty—it’s my sworn duty—to treat them well; to communicate with them well and provide accurate treatment with them and diagnose them well. If I don’t want to do this thing, I should refer them to somebody else who will do it.”

Focusing on improving health care settings and emphasizing comprehensive care brings providers into an educational mindset. Including concepts of provider success can also be helpful, such as the potential for increasing client base or renown within the community. Workshops and trainings were also suggested as a means to educate healthcare providers. Two representatives discussed the importance of avoiding discussions or lectures surrounding what is right and wrong, and instead emphasizing the importance of medical care. Finally, one stakeholder strongly emphasized the idea that even before education, the first step towards improving treatment of transgender individuals is to hold healthcare providers accountable and to make them responsible for their actions.

Discussion

Several themes emerged throughout this analysis. Most common was the assertion that transgender individuals in Lebanon experience stigma and discrimination in all parts of life. Rejection is common from both families and society at large, as is verbal, physical, and sexual abuse. Secondary to such discrimination come difficulties in obtaining education, employment, and housing, which can lead to poverty, survival sex work, and mental health co-morbidities. For transgender people, there is a significant risk to seeking healthcare, “coming out” to family or the community, and even simply to be oneself.

The success of the recent decision regarding a transgender man’s right to change his identity can be considered a starting point for positive change in Lebanon. Legal avenues can be used to promote transgender rights and acceptance within society, especially alongside the “protective diagnosis” of gender dysphoria. That being said, none of the representatives interviewed discussed how this diagnosis impacts the mental health of transgender individuals or the treatment provided by medical care providers, specifically mental health providers; more information regarding any underlying impact is necessary.

Within the healthcare system, a dearth of knowledge exists regarding transgender people and transgender health, and when combined with pervasive discrimination, negative attitudes and unethical practices abound. Transgender people accordingly often avoid seeking healthcare in order to protect themselves from the potential abuse that occurs within the system. The NGO representatives cited a common problem of identifying providers who are competent, respectful, and available to meet transgender-specific health needs. This lack of information applies to the availability of and access to several other aspects of transgender health, such as hormone therapy, health insurance coverage, or support groups. Broadly, few identified competent and non-discriminating providers exist, and there is little knowledge in the community about access to services and support—an important consideration in light of other economic and social obstacles that transgender people face in accessing care. This shortage of connectivity and information presents an opportunity for education and outreach to care providers, NGOs, and the transgender population to increase awareness of what is available and to create an integrated network of services.

Transgender individuals in Lebanon, specifically in Beirut, do have access to some medical care, legal aid, psychological support, and community support through local NGOs, however these services are not comprehensive. Services provided through specific NGOs are highlighted in Table 2.

There were several limitations to this project. First, the number of NGO representatives interviewed limited the comprehensiveness of perspectives and experiences that could be achieved. We are not able to characterize how prevalent negative attitudes or discriminatory practices are in the healthcare system, or what percentage of transgender people experience rejection by family and friends. Nevertheless, a significant level of agreement and many common themes emerged throughout the analysis, which may represent sampling saturation and indicate adequate numbers for the purpose of this project. Additionally, because the number of NGOs in Lebanon that have experience working with the transgender population is very small, our sample sizes may represent eligible stakeholders in the Beirut area. Our project findings are also consistent with previous work that performed a more thorough and quantified evaluation of negative public attitudes and discrimination towards transgender people in Lebanon and elsewhere.5, 14 This project was limited to Beirut and did not represent the perspectives of target groups outside this area; however it is commonly perceived that the majority of the transgender population, and subsequently the relevant stakeholders, live in Beirut.

Further studies may investigate differences in the context for transgender healthcare in rural areas compared to Beirut. Finally, because of IRB issues and difficulty reaching the transgender population, this project does not capture the most important stakeholder group—the transgender population itself. Future work should be done to examine these questions from the perspectives of transgender people in a way that elucidates their needs and input.

Recommendations and Conclusion

This analysis may lead to several appropriate next steps in the areas of education and training, awareness and communication, and advocacy through social, legal, and healthcare avenues. All recommendations emphasize basic principles of respect for transgender persons. Recommendations include:

  • Dissemination of information on current available resources to the transgender population and to health professionals at all levels of training
    • Resources around competent and culturally sensitive locations and providers for primary care, mental health care, hormone therapy, sexual health, surgical care, support groups, and other transgender-related services. LebMASH’s LebGuide is a growing directory of LGBT affirming providers who could help with this information.
  • Development and implementation of transgender health curricula early in the educational and training process; examples of effective curricula that can be adapted to fit the Lebanese context include:
    • Optional and recurrent transgender-specific sessions at health profession schools15
    • Combined interactive e-learning modules with an in-person, observation experience in a relevant location16
    • Case studies to address transgender-specific concerns alongside defining terms and identifying personal bias in an online, in-person, or hybrid format17
    • Online self-study module utilizing readings and videos along with self-assessment and case-based learning activities18
  • Networking and collaboration between providers, trained and knowledgeable in transgender health, and transgender-friendly NGOs and sexual health centers
  • Coordinate work in transgender health
  • Easily disseminate information to the transgender population
  • Easy referral to available services and resources
  • Provide quality and culturally sensitive integrated transgender-specific health services
  • Communication campaign in conjunction with NGOs and healthcare provider stakeholders to shift societal perceptions on transgender persons
    • Focus on educating and supporting parents and families of transgender individuals
  • Further research to direct future advocacy, communication, and health program work
    • Input from the transgender population
    • Input from healthcare providers

We hope this analysis will help all stakeholders for transgender health in Lebanon understand the current context, raise awareness and communication, and coordinate efforts to meet the needs of the transgender population. In the future, stakeholders should work together to improve the current context in a way that fosters a healthy environment for transgender individuals while also meeting the immediate sociocultural and healthcare system context in Lebanon.

Table 1. NGO Services Provided to the Transgender Community

Psychosocial– Psychotherapy, counseling– Psychosocial health (drama therapy, group support, life skills)– Psychological follow-up through transition– Psycho-education for family members
Medical– Free medical care– Free, rapid STI testing– Hormonal therapy– Referrals to transgender-friendly healthcare providers (psychiatrists, surgeons, endocrinologists, primary care)
Legal– Advocacy– Lobbying– Legal support (help with arrests, work on papers)
Social– Support groups– Connection to other transgender individuals through personal networks
Education– Knowledge production (needs assessments, manuals, advocacy plans, capacity building) to help local NGOs better serve the transgender population– Training for other NGOs to understand transgender people and needs– Training for healthcare providers to improve knowledge and understanding of transgender people and needs

Table 2. Local transgender-friendly NGOs

NGOProvision of services
The Legal AgendaAdvocacy group working to impact and alter laws in Lebanon to reduce monopoly of power and improve social justice, including transgender rights19
Helem– Sexual health center.– Low or zero-cost education and social support– Advocacy for transgender rights locally and internationally, especially through policy and local awareness– Works within the LGBT population to reduce HIV/AIDS and other STIs 20
Marsa– Sexual health center.– Free medical care, including mental health and primary care, rapid STI testing, sexual health services, hormonal therapy, and psychotherapy 21
MOSAIC– Psychotherapy, including throughout transition for individuals who choose to transition– Support group for transgender people; education for family members to encourage acceptance and understanding22
The Restart Center– Psychosocial, medical, and physical rehabilitation to survivors of violence and torture23

References

1 UNAIDS. Ending violence and discrimination against lesbian, gay, bisexual, transgender and intersex people. 2015. Geneva, Switzerland. Available at http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2015/september/20150929_LGBTI. Accessed July 28 2017

2 Makhlouf Y: Lebanese Judicial Ruling: Respecting the Right to Sex Change. 2016. The Legal Agenda. Available at http://legal-agenda.com/en/article.php?id=3125. Accessed March 3 2017

3 Kaplan, RL, Wagner, GJ, Nehme, S, Aunon, F, Khouri, D, Mokhbat, J: Forms of safety and their impact on health: An exploration of HIV/AIDS-related risk and resilience among trans women in Lebanon. Health Care for Women International 2015; 36(8): 917-935.

4 Kaplan, RL, McGowan, J, Wagner, G: HIV prevalence and demographic determinants of condomless receptive anal intercourse among trans feminine individuals in Beirut, Lebanon. Journal of the International AIDS Society 2016; 19(2).

5 Nasr N, Zeidan T: As Long as They Stay Away: Exploring Lebanese Attitudes Towards Sexualities and Gender Identities. 2015. Arab Foundation for Freedoms and Equality: Beirut, Lebanon. Available at http://gsrc-mena.org/as-long-as-they-stay-away-exploring-lebanese-attitudes-towards-sexualities-and-gender-identities/. Accessed February 27 2017

6 Kaplan, RL, Nehme, S, Aunon, F, deVries, D, Wagner, G: Suicide risk factors among trans feminine individuals in Lebanon. International Journal of Transgenderism 2016; 17(1): 23-30.

7 Human Rights Watch: It’s Part of the Job: Ill-treatment and Torture of Vulnerable Groups in Lebanese Police Stations. 2013. Available at www.hrw.org/report/2013/06/26/its-part-job/ill-treatment-and-torture-vulnerable-groups-lebanese-police-stations. Accessed February 12 2017

8 Nammour K: Dekwaneh’s “No Gay Land” Triggers Debate on Homophobia. 2013. Available at http://legal-agenda.com/en/article.php?id=2948. Accessed March 3 2017

9 Hafez A: Ruling Marks a First for Transgender People in Lebanon. 2016. Available at www.hrc.org/blog/ruling-marks-a-first-for-transgender-people-in-lebanon. Accessed February 12 2017

10 Byrne, J: License to be Yourself: Laws and Advocacy for Legal Gender Recognition of Trans People. 2014. Available at www.opensocietyfoundations.org/reports/license-be-yourself. Accessed February 17 2017

11 Malo S: Lebanese court lets transgender man change legal status to male. Thomson Reuters Foundation News. 2016. Available at http://news.trust.org//item/20160115185540-829my/. Accessed February 27 2017

12 Safdar, A: Transgender ruling in Lebanon an ’empowering’ moment. Al Jazeera. 2016. Available at www.aljazeera.com/indepth/features/2016/02/transgender-ruling-lebanon-empowering-moment-160206125311413.html. Accessed March 27 2017

13 Elali N: Transgender club victim speaks out. NOW. 2013. Available at https://now.mmedia.me/lb/en/reportsfeatures/transgender-club-victim-speaks-out. Accessed February 20 2017

14 Winter S, Chalungsooth P, Teh Y, et al.: Transpeople, Transprejudice and Pathologization: A Seven-Country Factor Analytic Study. International Journal of Sexual Health, 2009;21:96-118.

15 Braun HM, Garcia-Grossman IR, Quinones-Rivera A, Deutsch MB: Outcome and impact evaluation of a transgender health course for health profession students. LGBT Health 2017; 4(1).

16 Vance SR, Deutsch MB, Rosenthal SM, Buckelew SM: Enhancing pediatric trainees’ and students’ knowledge in providing care to transgender youth. Journal of Adolescent Health 2017; 60(4): 425-430.

17 Walker K, Arbour M, Waryold J: Educational strategies to help students provide respectful sexual and reproductive health care for lesbian, gay, bisexual, and transgender persons. Journal of Midwifery and Women’s Health 2016;61(6):737-743.

18Yingling CT, Cotler K, Hughes TL: Building nurses’ capacity to address health inequities: incorporating lesbian, gay, bisexual and transgender health content in a family nurse practitioner programme. Journal of Clinical Nursing 2017.

19 The Legal Agenda. 2016. Available at http://legal-agenda.com/en/. Accessed March 3 2017

20 Lebanon Support: Helem. 2017. Available at http://daleel-madani.org/profile/helem. Accessed July 28 2017

21 Marsa Sexual Health Center. 2017. Available at http://www.marsa.me/. Accessed March 3 2017

22 Mosaic. 2015. Available at https://www.mosaicmena.org/. Accessed March 3 2017

23 Restart Center. 2015. Available at http://restartcenter.com/Mainpage.html. Accessed March 3 2017

Journal of Homosexuality

Investigating the Islamic Perspective on Homosexuality

Junaid B. Jahangir PhD & Hussein Abdul-latif MD
To cite this article: Junaid B. Jahangir PhD & Hussein Abdul-latif MD (2015):
Investigating the Islamic Perspective on Homosexuality, Journal of Homosexuality, DOI:
10.1080/00918369.2015.1116344
To link to this article: http://dx.doi.org/10.1080/00918369.2015.1116344Investigating the Islamic Perspective on Homosexuality
Junaid B. Jahangir, PhDa and Hussein Abdul-latif, MDb

Department of Anthropology, Economics and Political Science, MacEwan University, Edmonton, Alberta, Canada; Pediatric Endocrinology, University of Alabama at Birmingham, Birmingham, Alabama, USA

Ahmed (2006) portrayed an Islamic perspective on “homosexuality” in the Journal of the Islamic Medical Association of North America (JIMA). We use quotation marks for the terms “homosexuality” and “lesbianism” to encompass both meanings of orientation and conduct that are interchangeably used based on the context. While Ahmed accepted the predominant Islamic position of the prohibition of homosexuality, he suggested medical professionals offer compassion in dealing with “sick homosexual patients.” He acknowledged societal taboo that limits any meaningful discussion of the issue. Furthermore, he argued against hatred and rejection that might serve
to drive homosexuals from the “right path” as shown by Islam. However, Ahmed biased his analysis with religious conviction and not scientific evidence, and as such the approach that he has used to broach the issue of homosexuality among Muslim medical professionals merits a critique.

Ahmed drew from various studies to summarize the scientific position on homosexuality. He qualified the prevalent psychiatric view that sexual orientation is inherent by summarizing theories that are prevalent amongst reparative therapy groups. He also associated mental health issues and fatal diseases with homosexuality rather than societal prejudice. As such, he distinguished between orientation and action, and based on “Islamic values” he counseled permanent celibacy for homosexuals. He referenced two sets of Qur’anic verses and a Hadith (saying attributed to the Prophet) to present the Islamic position. Eventually, he alluded to Spitzer’s work on changing orientation, suggested that clinicians have experience for aversion therapy, and cautioned against making homosexuality compatible with Islam.

Even though his article was published in 2006, it is important to critique it, because to our knowledge it is the only article of its kind in an Islamic journal. Furthermore, it not been effectively addressed, and many conservative Muslim thinkers, online counselors, and other professionals perpetuate similar opinions. Conservative Muslim leaders continue to sideline the predominant position of mainstream psychiatry and medical professional organizations, including the Lebanese professional organizations, which have recently issued statements affirming the position on the innateness of the sexual orientation of gays and lesbians and on the dangers of conversion or
reparative therapy (LebMASH, 2013).

The objective of this article is to use Ahmed (2006) as a focal point to critique several of the points raised that are also upheld by conservative Muslim leaders, and briefly present an alternate Muslim discourse. As such, the intended audience for this critique is Muslim counselors, professionals, and community leaders, who continue to ignore the predominant position among professional psychologists and psychiatrists on the acceptance of the sexual orientation of gays and lesbians and on the harms of reparative therapy, and who persist in perpetuating the framework used by the National Association for Research and Therapy of Homosexuality
(NARTH) due to their religious convictions.

This article will comprise four main sections. The first section will provide a critical summary of the views upheld by conservative Muslim leaders and their impact on Muslim gays and lesbians. The second section will contain a critique of reparative therapy as delineated in Ahmed’s article. By elaborating how past Muslim jurists understood homosexuality, the discourse will be shifted from the past to the present. The third section will examine Ahmed’s analogy of homosexuality with alcoholism, association with illicit sexual intercourse, link with fatal diseases, and the prescription of permanent celibacy. Finally, in the last section, the three sets of scriptural texts quoted by Ahmed will be briefly addressed followed by a brief outline of the case for Muslim same-sex unions. Opinions of conservative Muslim leaders Many conservative Muslim leaders continue to perpetuate positions espoused by NARTH. Krauss (2010) mentioned links from NARTH to argue that there is no evidence of people being born gay and to underscore the need for having positive loving male figures to help with identity development. In another online response, the questioner is informed that homosexuality is a severe illness that must be treated, one that arises due to weakness of faith or failing to pray (Muslims of Calgary, 2011). He is counseled that through repentance the haram (prohibited) desires of many homosexuals have disappeared, and he is therefore advised to get married (Muslims of Calgary,
2011).

However, sexual behavior has to be distinguished from sexual orientation. While sexual orientation refers to physiological drives, beyond conscious choice and profound feelings (APA Task Force on Appropriate Therapeutic
Responses to Sexual Orientation, 2009, p. 30), reparative therapists equate the suppression of behavior with a change in sexual orientation in the case of clients, who feign heterosexual desire to avoid hellfire in the hereafter (Grace, 2008). The APA Task Force Report (2009) also has indicated that what seems to shift in some individuals is not sexual orientation but sexual orientation identity (APA Task Force on Appropriate Therapeutic Responses to Sexual Orientation, 2009, p. 4).

In 2013, a Muslim clinical psychologist mentioned on the popular Onislam site that homosexuality is neither a mental disorder nor has any “cure,” but then asserted that people get “caught up in a deviant lifestyle” that “includes
drugs and deviant sexual practices” and that provides “an escape from the discomfort of childhood trauma” (Bachmeier, 2013). She also asserted, “many people, who call themselves homosexuals, were sexually abused when they were young . . . trying to fill an emotional void with a need for “father energy.” Like Ahmed, ignoring stigma and prejudice within conservative Muslim spaces, she prescribed celibacy to remain compliant with
morality.

Her comments on sexual orientation and sexual abuse are informed more by religious conviction than by scientific evidence, as the mainstream view among researchers and professionals who work in the area of child abuse reject the connection between a homosexual lifestyle and child molestation (Herek, n.d.). Causality claims are problematic due to the issue of reverse causality, as children who will later identify as LGBT are usually socially isolated and excluded, and therefore vulnerable to the perpetuation of abuse by those who prey on their uncertainties and insecurities (Katy, 2009). Furthermore, while sexual abuse may interfere with a survivor’s sexual development and behavior, it is highly unlikely that something as beautiful and wonderful as love and affection for another person could arise out of
something as ugly and painful as sexual abuse (Katy, 2009). Indeed, it seems rather strange to assert that a childhood rape programs the sexual orientation of the child so that all his future relationships built on love and affection are defined by childhood rape.

Kutty (2015) equated those who indulge in “homosexual behavior” with those who have been conditioned to fornicate, commit theft, or murder or who have become addicted to pornography. The tips he offered in the struggle to overcome homosexuality include elements of aversion therapy by associating the suffering of hell with same-sex behavior or reading Qur’anic verses depicting hellfire along with advising to pray for Allah’s help, cut off relations with those involved in a gay lifestyle, and to get married after repentance.

Kutty’s juxtaposing of pornography, in the context of gays and lesbians, allows some conservative Muslims to establish causality between pornography and sexual orientation. However, confessions on a site on asexuality reveal how some heterosexuals and asexuals occasionally watch homosexual pornography despite having no desire in masturbation or establishing a sexual relationship with members of the same gender (Asexual Q&A, 2013). This only confirms that sexual practices have to be distinguished from the constitutional sexual orientation of an individual.

It seems that conservative Muslim leaders are stuck on the old models of homosexuality from the middle of the 19th century when homosexuality was viewed through the lens of psychological immaturity, pathology, excessive parental control, insufficient parenting, hostile parenting, seduction, molestation, or decadent lifestyles (APA Task Force, 2009, p. 21). While studies have failed to support factors such as family dynamics or trauma in the development of sexual orientation (APA Task Force, 2009, p. 23), religious convictions prevent conservative Muslims from changing their viewpoints. In the context of British Muslim heterosexuals, Siraj (2009) pointed out that religiosity is the most influential variable directly associated with intolerance and opposition to homosexuality and that having a higher level of education did not have an influence on such attitudes. Many conservative Muslim leaders, like Ahmed, bias their analysis with religious conviction rather than scientific evidence. They view the human need of gays and lesbians for intimacy, affection, and companionship through the lens of “bad impulses” and “urges” and dehumanize them by reducing their life to the specific act of anal intercourse (Kesvani, 2015). Sidelining works such as Kugle (2010) and Menyawi (2012), which present a reasonable case for Muslim same-sex unions, conservative Muslim leaders prescribe lifelong celibacy (Ahmed, 2006), encourage false marriages (Qadhi, 2009), or perpetuate the status of gays and lesbians as sinners (Jackson, 2013).

The impact of conservative Muslim positions on Muslim gays and lesbians While not all conservative Muslim opinions are homophobic, all traditional Muslim opinions are heterosexist (Eidhamar, 2014). Community leaders promote heterosexism within the Muslim community, which includes the refusal to engage with LGBT organizations and publicly tackle homophobia within the Muslim community (Siraj, 2012). Continued public declarations of Muslim community leaders that homosexuality is an abnormality and a disease exposes Muslim gays and lesbians to discrimination (Siraj, 2012). Other consequences of the heterosexism instigated by Muslim community leaders include severe cognitive dissonance, as witnessed in online forums, in terms of the ability to harmonize faith and sexuality.

In one post from 2012, the author states that that while he feels disgusting and unclean, he cannot stop meeting guys in secret, and fasting has not helped in controlling his desires (Malik7, 2012). In 2014, an online post titled
“OCD About My Sexuality Is Driving Me Mad” was posted by a 19-year-old who stated that she has become sick to the point that she can’t eat or sleep (Salmah123, 2014). The same year a post titled “I Hate Myself for Being Homosexual” was posted by a 16-year-old, who stated that he is so sick of himself that he wants to commit suicide (Feraligator619, 2014). The online posts from 2015 include one titled “It’s Haram [prohibited], but I Can’t Help It” by a 15-year-old boy who states that he has always prayed and fasted but is beginning to develop strange feelings toward his roommate (Kertenkale, 2015). Such posts continue to be churned out online.

These online posts indicate the concern many religious youth have regarding their sexuality, and how praying and fasting does not alleviate their concerns. Such posts also suggest that Muslim leaders and professionals have failed to take a reasonable position on the human need for intimacy and affection, which at times contributes to a wide array of problems including alcohol abuse, suicide ideation, and unsafe sexual encounters (Depressedd, 2012).

Reparative therapy

Ahmed presented the prevalent view within mainstream medical and psychiatry professions that sexual orientation is an outcome of both genetic and environmental factors. He peppered this viewpoint by drawing out the limitations of the studies that indicate the innateness of sexual orientation. He alluded to theories paraphrased as “distant father domineering mother” that are generally prevalent among reparative therapy professionals. While Ahmed questioned the stronger peer-reviewed studies that support the innateness of sexual orientation, he does not critique the much weaker studies conducted in dubious settings. Ahmed alluded to a “recent” study that indicated the influence of teachers in promoting homosexuality among students. The reference actually mentioned Hatterer (1970), which delineated conversion therapy for male homosexuals. Given the dubious techniques (APA Task Force, 2009) used by
reparative therapists that include suggesting that fathers expose their penis to their young sons (Dobson, 2002) and given that the book was published in a time of immense prejudice against sexual minorities, the study cannot be taken seriously. According to a 1970 national survey, more than 70% agreed that “homosexuals are dangerous as teachers because they try to get sexually involved with children,” a number that has come down drastically over the years, as there is no scientific evidence that suggests that homosexuals are less likely than heterosexuals in controlling their sexual urges, refraining from the abuse of power, and exercising good judgment in their employment settings (Herek, n.d.).

Ahmed also alluded to Spitzer’s work on successfully changing the sexual orientation of homosexuals. Spitzer (2003) had concluded that reparative therapy could reorient a predominantly homosexual orientation to a predominantly heterosexual one, and therefore such therapies should not be banned. However, Grace (2008) summarized the criticisms leveled against Spitzer’s controversial study, of which the salient ones are as follows. Spitzer’s sample suffered from the self-selection bias, as religion was important for a majority who were not only associated with reparative therapy but also spoke publicly in its favor. The results of the study were based on self-reporting and hence were marred with the associated issues of self-deception, exaggeration, and even lying. Moreover, the issues of imperfect recall or poor memory tainted the results as participants were trying to recall events from about 12 years. Above all, Spitzer did not establish a cause-effect relationship between changes in sexual orientation and prayer or therapy, a point that has been used by reparative therapy proponents against studies that aim to show the constitutionality of a homosexual orientation.

Spitzer (2003) himself conceded that scientific evidence on the efficacy of reparative therapy based on randomized assignment of individuals to a treatment condition and valid assessment of target symptoms before and after treatment is not available. In later interviews, Spitzer mentioned that not only was his sample self-selected but also he suspected that the vast majority of gay people would be unable to change their orientation. He further opined that perhaps only “3% might have a malleable orientation” and that his study results were being “twisted by the Christian right” (Robinson, 2002). Given the backdrop of such criticisms, in 2012 Spitzer apologized for his study by stating, “I owe the gay community an apology . . . As I read these commentaries [criticisms of the Spitzer study], I knew this was a problem, a big problem, and one I couldn’t answer . . . it’s the only regret I have, the only professional one” (Carey, 2012).

There is no scientific evidence for any long-term success of sexual reorientation therapy. There are serious methodological issues in peerreviewed journal articles from 1960–2007, and none of the more recent research from 1999–2007 allows for any conclusions on the efficacy or safety of sexual orientation change efforts (SOCE) (APA Task Force, 2009, p. 2). Even Charles Socarides (d. 2005) and Joseph Nicolosi, who helped found NARTH, respectively, acknowledge the impossibility of the client giving up the “homosexual need” and that reparative therapy is not for all homosexuals (Grace, 2008). NARTH governing board member Julie C. Harren (2004) mentioned at the 2004 NARTH Conference that “attractions and desires are like feelings; they come from deep within us and are not a conscious choice on our part.” Freud (d. 1939), whose idea that “people are born bisexual and can move along the sexuality continuum” forms the foundation of reparative therapy (Carey, 2012), and who viewed homosexuality as a developmental arrest, concluded that changing a homosexual orientation was unlikely to be successful (APA Task Force, 2009, p. 21).

According to Dr. Nicolosi, one third of patients at the Thomas Aquinas Psychological Clinic fail to change, and one third engage in occasional samesex behavior, whereas the remaining one third have desires but choose to remain celibate. Essentially, Dr. Nicolosi has admitted to a 100% failure rate of reparative therapy (Robinson, 2006). Jack Drescher, who has treated men who have undergone conversion therapy, actually stated: Many people who try this treatment tend to be desperate, very unhappy and don’t know other gay people. I see people who’ve been very hurt by this. They spend years trying to change and are told they aren’t trying hard enough. (Robinson, 2006)

Grace (2008) indicated that all major U.S. mental health associations have issued statements warning against the potential harmful effects of reparative therapies on clients. The negative impact of SOCE include depression, hopelessness, loss of faith, deteriorated relationships with family, poor self-image, social isolation, intimacy difficulties, self-hatred, sexual dysfunction, suicidal ideation, feelings of being dehumanized, increase in substance abuse, and high-risk sexual behaviors (APA Task Force, 2009, pp. 42, 50). Grace (2008) mentioned that both the American Psychological Association in 1997 and the American Psychiatric Association in 1998 have rejected therapies based on the assertion that homosexuality is a mental illness. Excerpts from statements of both organizations on reparative therapy are as follows (Human Rights Campaign, n.d.).

In the last four decades, “reparative” therapists have not produced any rigorous scientific research to substantiate their claims of cure. . . . The potential risks of reparative therapy are great, including depression, anxiety and self-destructive behavior, since therapist alignment with societal prejudices against homosexuality may reinforce self-hatred already experienced by the patient. . . . Therefore, the American Psychiatric Association opposes any psychiatric treatment, such as reparative or conversion therapy which is based upon the assumption that homosexuality per se is a mental disorder or based upon the a priori assumption that the patient should change his/her sexual homosexual orientation. (American Psychiatric Association, 2000)

The American Psychological Association reaffirms its position that homosexuality per se is not a mental disorder and opposes portrayals of sexual minority youths and adults as mentally ill due to their sexual orientation; . . . concludes that there is insufficient evidence to support the use of psychological interventions to change sexual orientation; . . . encourages mental health professionals to avoid misrepresenting the efficacy of sexual orientation change efforts by promoting or promising change in sexual orientation when providing assistance to individuals distressed by their own or others’ sexual orientation. . . (Anton, 2010) Despite all the harms alluded to by mainstream psychiatrists, which includes suicide (Farley, n.d.), Ahmed (2006) indicated that a clinician must have experience in aversion therapy. Aversion treatments have included shame aversion, systematic desensitization, orgasmic reconditioning and satiation therapy, through methods that include inducing nausea, vomiting, providing electric shocks, having the client snap an elastic band around the wrist upon arousal, prayer, support groups, and psychotherapy (APA Task Force, 2009, p. 22, 31). Negative effects of aversive forms of SOCE have included loss of sexual feeling, depression, suicidality, and anxiety (APA Task Force, 2009, p. 3).

Indeed, SOCE, whether in the form or reparative therapy or aversion therapy, goes against the medical professional’s oath of doing no harm as well as the Prophet’s teaching paraphrased as “Do not harm and accept no harm.”

The shift from liwat to sexual orientation

Conservative Muslim scholars dehumanize gay men when they view homosexuality
through the lens of a singular sexual act. Muslim scholar
Muhammad Salih Al-Munajjid defines homosexuality as follows.
Homosexuality means having intercourse with males in the back passage. This was
the action of the accursed people of the Prophet Lot. In Shariah terminology it
refers to inserting the tip of the penis into the anus of a male (Munajjid, n.d.).
However, past exegetes and jurists viewed sexual activity between males
as based on age and status stratified asymmetrical relationships (Ali, 2006,
p. 84). They viewed homosexuality through the lens of liwat, defined as anal
penetration of beardless youth, male slaves (Ali, 2010, p. 11), or those
suffering from ubnah—an incurable disease that afflicted the anus. In contrast
to anal intercourse, liwat was viewed as an action that inflicted subordination
and humiliation on the receptive partner, who submitted for
reasons other than pleasure. The insertive partner’s desire was viewed as
the same that was directed toward women and therefore could be sated with
lawful female partners (Ali, 2006, p. 88). Scholars such as Zaylai
(d. 1342–1343) and Sarakshi (d. 1096) stated, respectively, that people of
sound reason coveted both the vagina and anus (Lange, 2008, p. 211).
Likewise, Al Nawawi (d. 1278) stated that the male youth is like a woman
as his beauty is similar to a woman’s beauty and that he is desired as she is
desired (Rouayheb, 2005, p. 114).

Past Muslim scholars viewed homosexuality based on sociocultural norms
and medical knowledge of their times. They viewed liwat and sihaq (rubbing
of vulvae) as diseases to be cured, based on the medical knowledge of their
times as shaped by the Greek physician Galen (d. 200). While the physician
Ibn Sina (d. 1037) denied a genetic cause for the disease, which he blamed on
imagination (Rosenthal, 1978), Al Razi (d. 925) considered ubnah to be
genetic in that it was a result of the contest between the female sperm and
the male sperm (Zeevi, 2006, p. 38). He prescribed enemas and sensual
massages of the private parts, seemingly based on the Galenic model of
humoral effect (Zeevi, 2006, p. 38), asserting that the disease, if prolonged,
would be incurable (Rosenthal, 1978). Dawud Al Antaki (d. 1599) explained
ubnah, through the presence of a boric substance in the veins of the rectum
that caused an itch in the anus (Rouayheb, 2005, pp. 19, 20). Jafar Sadiq
(d. 765) is reported to have suggested that a person suffering from ubnah sit
on a chopped-off hump of a camel (Juma, n.d.). The physician Al Kindi
(d. 873) deemed that sihaq was explained by an itch in the labia, and
Yuhanna Ibn Masawayh (d. 857) indicated that sihaq was a consequence of
a nursing woman eating celery, rocket, melilot leaves, and flowers of a bitter
orange tree (Amer, 2009). Likewise, Al Samawuli Ibn Yahya (d. 1180), wrote
of the physiological causes of sihaq through rationales of coldness, shortness,
deficiencies, or illnesses of wombs (Habib, 2009, pp. 84, 85).

Islamicate medical tracts also indicate that the human body would have a
feminine or masculine, active or passive, and penetrating or penetrated type
of sexuality (Zeevi, 2006, p. 22). As such, past jurists operated with the model
that men were the insertive partners, whereas women were the receptive
partners. Any deviation from this model was viewed as “unnatural.” The
religious scholar Al Raghib (d. 1108–1109) described a woman sodomizing
an effeminate man with a dildo as an ultimate sexual irregularity and
explained sihaq through the aversion to phallic objects and penetration
(Rowson, 1991, p. 68). Daniel Boyarin argued that the word neqeba for
females in Talmudic Hebrew and Aramaic referred to orifice bearer and
that gender was constructed on the basis of penetration and being penetrated
(Najmabadi, 2008, p. 292). Likewise, the Qur’an uses the words dhakr (active
and nonreceptive) and untha (receptive) for men and women, respectively.
The above indicates that it does not seem reasonable to superimpose the
framework of liwat to understand the concerns of Muslim gays and lesbians.
In the absence of developments in psychology, past jurists could not account
for sexual orientation. Amidi (d. 1233) stated that jurists based their opinions
on the apparent, as hidden things were left to God (Lange, 2008, p. 193).
While they ruled on the issue of liwat, they did not consider the issue of
same-sex unions, which would have been anachronistically absurd for them.

Muslim scholar Muhammad Shahrur (b. 1938) indicated that the jurists
were simply articulating the Weltanschauung or worldview of their times and
that, therefore, doctrines of the traditional schools of jurisprudence as well as
the traditional interpretations of the Qur’an are not binding on modern
Muslims as these interpretations and doctrines were based on assumptions
based on the knowledge base of their times (Hallaq, 1999, pp. 246–251). Thus
the discourse on homosexuality has to be shifted from that of liwat perpetrated
in the context of exploitation and disease to one based on the sexual
orientation of a minority with a constitution for the same gender. Some may
argue that an identity based on sexual orientation be eschewed, yet identity
comprises a coherent sense of spirituality, sexuality, ethnicity, disability,
gender, and other socioeconomic variables (APA Task Force, 2009, p. 60).
Moreover, an identity that includes sexual orientation provides self-esteem,
belonging, and meaning (APA Task Force, 2009, p. 62).

In this context, Dr. Qazi Rahman, a lecturer at the University of London
and co-author of the book Born Gay: The Psychobiology of Sex Orientation
(Wilson & Rahman, 2005) can be quoted as follows.
As far as I’m concerned there is no argument any more—if you are gay, you are
born gay. (BBC News, 2008, June 16)
Likewise, Dr. Hashim Kamali from the International Institute of Advanced
Islamic Studies in Malaysia has asserted that sexual orientation is increasingly
considered inherent by not only science but also fiqh (Islamic jurisprudence).
Fiqh and science both confirm that sexual orientation is latent within each
individual, emerging in complex interactions between one’s biological make-up
and early childhood. Current research is pushing slowly but steadily towards the
conclusion that sexual orientation is largely inherent. (Kamali, 2011, August 11)
The constitutionality of the sexual orientation of gays and lesbians can also
be supported on the basis of Ghazali’s (d. 1111) assertion that Allah’s
creations are not subject to the arrows of accident (Kugle, 2003, p. 198).
The Qur’an can also be read to note that Allah creates whatsoever He wills
and that includes, according to verses 17:84 and 30:22 (Bucar & Shirazi,
2012), those with alternative inner dispositions, as captured by the words
shakila (manner) and lawn (color).

The connection of homosexuality with mental health issues and fatal
diseases

Unlike many conservative Muslims, Ahmed has not appeared to invoke conspiracy
theories to explain why homosexuality was declassified as a mental
disorder. Grace (2008) referenced Friedman (1988) and Drescher (1999), who
maintained that the American Psychiatric Association removed homosexuality
from the Diagnostic and Statistical Manual of Mental Disorders (DSM) III for
scientific reasons as there was inadequate research to support the pathologization
of homosexuality. Grace (2008) even mentioned Nicolosi, who maintained
that the declassification of homosexuality as a disorder was driven by the
objective of ending social discrimination and based on the recognition that
there has never been a guarantee on the treatment of homosexuality.

Over the years, major health and mental health professions (Just the Facts
Coalition, 2008) including the American Academy of Pediatrics, have stated
that homosexuality is not a choice and that it cannot be changed (Healthy
Children, 2008). In 2013, the Lebanese Psychological Association affirmed
that “homosexuality is not a mental illness and thus requires no treatment”
(Abdesammad, 2013, July 18), and the Lebanese Psychiatric Association
strongly opposed SOCE and declared the following:
Homosexuality is not a mental disorder and does not need to be treated . . . in itself
does not cause any defect in judgment, stability, reliability or social and professional
abilities. The assumption that homosexuality is a result of disturbances in
the family dynamic or unbalanced psychological development is based on wrong
information. (Abdesammad, 2013, July 12)

In 2013, the Lebanese Medical Association for Sexual Health released a
position statement on SOCE, which included the following excerpt:
Efforts to change sexual orientation are not based on any sound scientific evidence.
On the contrary, this practice has been abandoned due to proven failure and
serious harmful effects. Dr Spitzer, the father of reparative therapy recanted his
position on reparative therapy in 2012. . . . Based on the above, the Lebanese
Medical Association for Sexual Health (LebMASH) urges healthcare providers in
Lebanon to refrain from this unethical and potentially harmful practice. We also
urge health care organizations to take a strong position against such practices.
(Abdesammad, 2013, May 17)

However, Ahmed associated homosexuality with mental health problems
and alluded to a “consensus” on this issue based on the articles released in
the October 1999 issue of the Archives of General Psychiatry. He specifically
mentioned three references—Remafedi (1999), Herrell et al. (1999), and
Fergusson, Horwood, and Beutrais (1999). Herrell et al. (1999) clearly concluded
that “the underlying causes of the suicidal behaviors remain unclear.”
Moreover, it is not clear whether any of these studies accounted for societal
prejudice in their studies. In subsequent studies, societal prejudice is
specifically pinpointed as the factor contributing to suicidal behavior. While
Bagley and D’Augelli (2000) associated suicidal behavior with homophobic
legislation, Mathy (2002) indicated that changing cultural attitudes appear to
be more effective in curbing suicidal behavior.

While enablers of homophobia argue that being gay causes health and
social problems (Banks, 2003, p. 11), research has indicated that gays,
lesbians, and bisexuals (GLB) and heterosexuals are equivalent in psychological
and psychosocial functioning but that GLB individuals have shorter life
expectancy and face higher health risks and social problems, primarily due to
the chronic stress of dealing with stigmatization and societal hatred due to
homophobia (Banks, 2003; Bux, 1996; Cochran & Mays, 1994; Gillow &
Davis, 1987; Greene, 1994; Ross, 1978; Savin-Williams, 1994; Ungvarski &
Grossman, 1999 as cited in Banks, 2003). While being GLB is not harmful to
one’s physical or psychological health (O’Hanlan, 1995; Remafedi, French,
Story, Resnick, & Blum, 1998; Ross, Paulsen, & Stalstrom, 1988; Wayment &
Peplau, 1995 as cited in Banks, 2003), GLB suffer problems associated with
homophobia, which include higher rates of depression, anxiety, substance
abuse, loneliness, and other psychological distress (Banks, 2003; Morrow,
1993; Rudolph, 1988, 1989; Ungvarski & Grossman, 1999; Ziebold &
Mongeon, 1982; Kehoe, 1990 as cited in Banks, 2003).

The stress caused by homophobia may be worse than other stressors
because of the loss of family and friend support systems (Bradford, Ryan,
& Rothblum, 1994; DiPlacido, 1994; Brooks, 1981; Larson & Chastain, 1990
as cited in Banks, 2003). Among other problems, internalized homophobia
results in lower self-esteem, increased feelings of guilt, demoralization, alienation,
and isolation (Bux, 1996; Meyer & Dean, 1996; McGregor et al., 2001;
Flowers & Buston, 2001 as cited in Banks, 2003). Indeed, repressing feelings
and concealing one’s homosexuality not only cause unusual stress (Roberts &
Sorenson, 1995; D’ Augelli, Hershberger, & Pilkington, 1998; Ungvarski &
Grossman, 1999; Herek, 1991; Sewell et al., 2000; Mays & Cochran, 2001 as
cited in Banks, 2003) but also negatively impact physical health (Larson &
Chastain, 1990). On the other hand, openness about sexual orientation is
associated with better psychological adjustment (Bradford et al., 1994), and
self-acceptance has been found to be the largest predictor of mental health
(Hershberger & D’Augelli, 1995).

According to the American Psychological Association (2000), stress related
to stigmatization of homosexual orientation explains the differences in the
psychological functioning between heterosexual and homosexual individuals
(Grace, 2008). A growing body of evidence concludes that prejudice and
discrimination are a major source of stress for sexual minorities, known as
minority stress, which is a factor in mental health disparities in some sexual
minorities (APA Task Force, 2009, p. 1). Indeed, social stigma and prejudice
are main reasons why sexual minorities seek to change their sexual orientation
(APA Task Force, 2009, p. 68).

Ahmed (2006) asserted that “young people who are engaged in homosexual
behavior are at an increased risk of mental health problems and
suicidal behavior” (p. 30). He went on to list problems that include rejection
by family, friends, and society and academic and job-related problems.
Although he stated that “hate and rejection will not show anybody the
right path,” he attributed mental health problems to homosexual behavior
instead of societal prejudice. It is important to underscore that “association is
not causation” and that it is more reasonable to state that societal prejudice
leads to many of the problems observed among gay youth.

A 2008 study prepared for the U.S. Department of Health and Human
Services on the prevention of suicide rates among LGBT youth directly
indicated “stigma and discrimination” as risk factors for suicide (Suicide
Prevention Resource Center, 2008). Waldo (1999) indicated that GLB individuals
who experience greater heterosexism exhibit greater job withdrawal.
High school dropout rates exacerbate employability issues for GLB individuals,
who drop out due to verbal and physical harassment (Roberts &
Sorensen, 1995) and feelings of isolation (Rivers, 2000). Indeed, sexual
minority youth in schools with support groups have reported lower rates of
suicide attempts and victimization than those without such groups, and such
support groups were associated with improved academic performance, safety
of sexual minority youth, and college attendance (APA Task Force, 2009,
p. 78).

Michael Benibgui’s (2011) doctoral thesis, as cited by Concordia News
(2011, February 2), indicated that compared to their heterosexual peers,
suicide rates are 14 times higher among GLB high school and college
students, and also established the link between the stress of being rejected
or victimized due to sexual orientation with physiological response through
abnormal cortisol activity. Hatzenbuehler (2011) found that GLB youth in
the last 12 months were more likely to have attempted suicide compared to
heterosexuals (21.5% vs. 4.2%) and that their risk of attempting suicide was
20% higher in unsupportive environments compared to supportive ones.
Hatzenbuehler and Keyes (2013) found that lesbian and gay youth living in
counties with fewer school districts with anti-bullying policies were 2.25
times more likely to have attempted suicide in the past year compared to
those living in counties where more districts had these policies.
Ahmed also associated homosexuality with fatal diseases such as AIDS.
Specifically, he lumped homosexuality with promiscuous heterosexual relationships
and drug abuse and stated that they lead to fatal illnesses such as
hepatitis B and C, AIDS, and other STIs. He did not provide a reference for
statistics that he provided, which indicated that 60% of new HIV infections
occur among homosexuals. Two potential issues can be highlighted with
regard to these connections.

First, it would be erroneous to equate homosexuality with promiscuity. It
would be more appropriate to distinguish between monogamous relationships
and promiscuity regardless of orientation. There are promiscuous
heterosexuals just as there are monogamous homosexuals. In fact, much of
Islamic law deals with promiscuity among heterosexuals under the label of
zina (illicit sexual intercourse). Furthermore, in the context of sub-Saharan
Africa, we would not erroneously associate AIDS with heterosexuals but
rather with unsafe sexual encounters. As such, the association between gay
men and HIV infections is irrelevant—specifically, in the context where the
risky activity of unprotected anal sex is absent. Not all gay men indulge in
anal sex, just as some heterosexuals indulge in anal sex. In fact, according to
Shii jurisprudence, anal sex is permissible with one’s wife with her approval,
albeit it is strongly disliked (Lankarani, n.d.). While anal sex is deemed
forbidden in Sunni jurisprudence, queries on various online Islam Q&A
Web sites indicate how husbands pressure wives for anal sex (Islamweb,
n.d.) and threaten them with divorce for not complying with their demand
(Fathimath, 2013). A sex columnist wrote on the distinction between anal sex
and being gay as follows.

Many gay men do not have anal sex. In fact, oral sex and mutual masturbation are
more common than anal stimulation among gay men in long-term relationships. . . .
Studies indicate that about 25% of heterosexual couples have had anal sex at least
once, and 10% regularly have anal penetration. (Alice! Health Promotion, 1996,
May 10)
Second, a distinction needs to be made between gay men and men who have
sex with men (MSM), as the statistics for gay men with HIV infections might be
conflated due to the failure to distinguish between. This is an important point
as usually MSM are not necessarily gay. Such people indulge in homosexual
acts for a wide variety of reasons that could include making quick money
(Kort, 2014), or perhaps drugs. Furthermore, they might indulge in homosexual
acts in the absence of access to women in prisons or in heavily gendersegregated
cultures. Alhamad (2013) has reported that in a closed culture such
as Saudi Arabia, childhood sexual abuse, especially by relatives, is prevalent,
which potentially affects sexual behavior to the extent that some victims
engage in anal intercourse with their wives or other males, as a form of
misdirected revenge. Nadya Labi (2007) evoked this point through the experience
of a Filipino expatriate in Saudi Arabia as follows:
Francis . . . reported that he’s had sex with Saudi men whose wives were pregnant or
menstruating; when those circumstances changed, most of the men stopped calling.
“If they can’t use their wives,” Francis said, “they have this option with gays.”

HIV and other diseases cannot be associated with sexual orientation.
Several reasons explain the increased rates of HIV and AIDS in GLB individuals.
First, given that GLB individuals resort to illicit drug and alcohol use
due to societal rejection, and since illicit drug and alcohol users often engage
in unsafe sex, GLB individuals contract HIV/AIDS (Ostrow, 2000; Rosenberg
et al., 2001 as cited in Banks, 2003). Second, GLB individuals with higher
internalized homophobia engage in risky sexual behavior at a greater rate
than GLB individuals with lower internalized homophobia (Meyer & Dean,
1996; O’Hanlan et al., 1996 as cited in Banks, 2003), as they were less
affiliated with the GLB community and therefore had less access to safersex
information and resources (Williamson, 2000). Third, GLB who live at
the margins of society are more vulnerable to HIV/AIDS (Peersman,
Sogolow, & Harden, 2000) and, finally, negative life events, depression, and
anxiety have been found to be predictors of risky sexual behaviors (Graham,
Kirscht, Kessler, & Graham, 1998; Lesserman et al., 2000 as cited in Banks,
2003).

According to groups that work on HIV prevention, it is stigma and
discrimination that drives sexual activity underground, thereby increasing
the probability of HIV infections (Global Health Council, n.d., Avert, n.d.).
Research conducted at San Francisco State University found that compared
with LGBT young people who were not rejected by their parents, highly
rejected LGBT young people were 8 times more likely to attempt suicide, 6
times more likely to report high levels of depression, 3 times more likely to
indulge in substance abuse, and 3 times more likely to be at high risk for HIV
and STIs (Human Rights Campaign, n.d.). Likewise, Cole, Kemeny, Taylor,
and Visscher (1996), as cited in Banks (2003), found for their sample that
incidence of cancer and moderately serious infectious diseases increased in
direct proportion to the extent to which homosexual identity is concealed.
The equation of homosexuality with alcoholism, illicit sexual intercourse,
and the prescription of lifelong celibacy
Ahmed stated that even if it is argued that alcoholism and obesity are
genetically determined, the posited solution is that of self-control. In a
similar vein, he prescribed restraint for gays and lesbians. He further stated
that people who indulge in homosexual conduct are committing a sin
analogous to illicit sexual intercourse. Thereafter, he stated that an individual
can live a normal life without marriage or without any sexual conduct.
Essentially, by comparing homosexual conduct with alcoholism and illicit
sexual intercourse, he is prescribing celibacy to gays and lesbians. However,
there are problems with these analogies.

Based on analogical reasoning, jurists such as Abu Hanifa (d. 767) and Ibn
Hazm (d. 1064) rejected the analogy of liwat with zina. Abu Hanifa reasoned
that the anus was not a faraj—(sexual organ) and that in liwaṭ the attraction
is one-sided in contrast to zina. Ibn Taymiyyah (d. 1328) reasoned that in the
absence of ubnah or financial reasons, the receptive partner did not desire
liwat (Ibn Taymiyyah, n.d.). Razi (d. 1209) reasoned that liwat led to hatred
and humiliation and might lead the passive partner to kill the active partner
(Razi, n.d.). Past jurists emphasized that, in contrast to liwat, zina included
the danger of procreation for a child born outside a legally sanctioned
relationship whose pedigree would be eternally disputed and who may
grow up without a father (Lange, 2008, p. 210). Furthermore, they argued
that liwat was half as less widespread than zina for there was only one
solicitor in the act, as they assumed that males generally do not desire to
be penetrated (Lange, 2008, p. 212).

According to Ibn Hazm (d. 1064), Allah has not forbidden anything
without providing better lawful substitutes (Ibn Hazm, n.d.). Ibn Qutayba
(d. 884) indicated that while God prohibited fornication, usury, wine, gambling,
and swine, He allowed marriage, trade, many beverages, competitive
sport, and the flesh of nonpredatory beasts and birds (Mahfazah, personal
correspondence, April 23, 2012). This suggests that if marriage has been
allowed in lieu of fornication, then the prescription of permanent celibacy
not only imposes undue hardship but also binds gay Muslims without a
reasonable alternative, which violates the Islamic ethos of human dignity and
justice. While some may argue that marriage to an opposite-gender spouse
could be the alternative that the Sharia offers gay Muslims, such a false
marriage violates the Islamic ethos of justice for both the gay and the straight
spouse.

Likewise, the comparison of homosexuality with alcoholism does not seem
reasonable as a basic intimacy need for which there exist no alternatives
cannot be compared to an addiction. Furthermore, while the harms of
alcoholism may be compared with those of heterosexual or homosexual
unsafe sexual encounters, such an equation fails with monogamous longterm
same-sex relationships. Indeed, in contrast to depression and alcohol
dependence, homosexuality does not cause marked distress or impairment
(Carey, 2012, May 18).

Moreover, it is minority stress of dealing with stigmatization and societal
hatred that drives GLB individuals to alcoholism and substance abuse.
According to Alderson (2001), as cited in Banks (2003), not accepting
one’s sexuality due to homophobia may be causally related to higher incidence
of alcohol abuse in the gay community. Likewise, Williamson (2000)
asserted that internalized homophobia in GLB individuals results in alcohol
abuse. Based on 17 studies, Banks (2003) indicates that the percentage of
GLB individuals who indulged in alcohol abuse ranged from 7% to 59%, with
18% as the mean. GLB individuals were found to be 0.94 times to 7 times as
likely as the heterosexual control sample to abuse alcohol. The median in this
regard was found to be 1.7 times. Likewise, based on meta-analyses, King
et al. (2008) found that compared to heterosexuals, GLB individuals were
twice as likely to attempt suicide, 1.5 times more likely to have depression
and anxiety disorders, and 1.5 times more likely to indulge in alcohol and
substance abuse. It is therefore not surprising that a poster at an online
Islamic site indicated that, struggling with his sexuality, he tied a noose
around his neck, indulged in alcohol, acquired an STI, fasted every day,
deleted his music collection, distanced himself from friends, went back and
forth, and ended up being quite depressed (Depressedd, 2012).

Finally, the prescription of celibacy does not seem reasonable as Islam
recognizes basic human sexual needs and provides the legitimate avenue of
marriage to satisfy emotional and physical needs. No Qur’anic verse indicates
that procreation is the teleology of marriage for the purpose of marriage;
based on verse 30:21, it is rather tranquility, compassion, and mawaddah
(affection) between spouses (Menyawi, 2012). Many jurists defined the purpose
of marriage not through procreation but through sexual enjoyment (Ali,
2003, p. 179). In fact, in the Prophetic tradition, sex within wedlock that leads
to tenderness and care is also viewed as a form of charity.

An excerpt from a popular Islamic site in the context of widows and
divorced women is quite relevant to the case of Muslim gays and lesbians.
Do we really imagine that by providing only food, clothing, and shelter to widows and
divorced women that all their needs in life are met, and they can live locked away from
intimate interaction with the opposite sex—forever? . . . How could a human being,
let alone a Muslim, suggest such a lifestyle for a fellow human being—especially when
it’s a lifestyle they don’t accept for themselves? (Umm Zakiyyah, 2014)
For many people, permanent celibacy is not feasible; therefore, by asking
gays and lesbians to remain abstinent for their whole lives, we are essentially
ensuring that they either fail to live up to that standard or suffer the mental
consequences of such a prescription. The spiritual struggles of those dealing
with homosexual orientation include coping with intense guilt due to the
inability to stop committing unforgivable sins (APA Task Force, 2009, pp.
46–47). Such spiritual struggles have been associated with anxiety, panic
disorders, depression, and suicidality, and while a minority of research
participants have been willing to make sexual abstinence a life goal, it has
not always worked in the long term even for them, and the negative impact
of electing celibacy has included depression and loneliness (APA Task Force,
2009, pp. 47, 61). Even a conservative scholar such as Abdul Hakim Murad
has acknowledged that given that long-term abstinence fails for most individuals,
as they are not super moral figures, most Muslims with a same-sex
orientation would commit transgressions (Ali, 2006, p. 88). Another scholar
counsels against fighting nature through a celibate lifestyle (Amjad, 1997).
Thus if Muslim scholars accept that permanent celibacy is against human
nature and increases the probability of committing sins, then would it not be
reasonable to apply the same logic for gays and lesbians?
Prescriptions that ignore legitimate human needs lead to taklif ma la
yutaq (creation of obligations that cannot be met). The jurist Shatibi
(d. 1388) recognized that some human dispositions are so inherent that
to deny them would be to harm human beings irreparably (Emon, 2010,
p. 175). Likewise, Hallaq noted that none of the attributes that a man is
born with is subject to adverse legal rulings (Hallaq, 1999, p. 182). This
substantiates rejecting the prescription of permanent celibacy for Muslim
gays and lesbians.

The three scriptural texts

Ahmed based his views on the prohibition of homosexuality by referencing
two sets of verses, 26:160–175 and 7:80–81 and a Hadith. However, it is
important to note that the words fornicate in verse 26:265 and adultery in
verse 7:80, as quoted by Ahmed, are improper translations of atatoona
(approach) and fahisha (enormity), respectively. Had the Muslim jurists
understood these words as alluding to adultery, they would not have disagreed
on the penalties they prescribed for liwat. Stripped from their context, the
principal verses that are usually quoted by conservative Muslims are as follows:
Most surely you come to males in lust besides females; nay you are an extravagant
people (Qur’an. Shakir’s translation. Verse 7:81, n.d.)
What! Do you come to the males from among the creatures? And leave what your
Lord has created for you of your wives? Nay, you are a people exceeding limits
(Qur’an. Shakir’s translation. Verse 26:165–166, n.d.)

The key phrases used in these verses are atatoona L-dhukrana (26:165) or
latatoona L-rijjala (7:81 and 27:55), both of which refer to approaching the
men, and L-nisai (7:81), which refers to the women. The definite article
L (the) is used to particularize both men and women, which may specifically
refer to the traveling men visiting Sodom and the wives of the people of Lut
(Lot), respectively. The synonym of the word rijjala in verse 7:81 is dhukrana,
as used in verse 26:165, which, according to the classical Arabic
dictionary Lisan Al Arab, means male, male genital, hard/harsh, or nonreceptive.
Likewise, the synonym for the word nisa in verse 7:81 is untha,
which has the connotation of female, female genital, soft, or receptive. Thus it
would be reasonable to elicit the understanding that the Qur’an is admonishing
the people of Lut for approaching men—specifically, the travelers—
who are nonreceptive to their advances, instead of women—specifically, their
wives—who may be more receptive to their advances. Such a one-sided
sexual pursuit of an unwilling partner constitutes rape, as consent is absent
in the receptive partner, a point assumed by the past jurists. As such,
superimposing the verses on the people of Lut onto Muslim gays and lesbians
is unreasonable and unjustified.

Apart from the two sets of verses, Ahmed presented a Hadith text, which
indicates that Allah has cursed the one who engages in bestiality and liwat, to
substantiate his view on the prohibition of homosexuality. However, the
collection on Hadith narrators Tahtheeb Al Kamal indicates severe and
clear weaknesses in the transmission chain of this text. The narrators
Ikrimah (d. 723–24) and Amro Bin Abi Amro have been deemed untrustworthy
or weak by past Hadith experts such as Sa’id Ibn Al Misayeb (d. 715),
Malik Ibn Anas (d. 795), Abu Dawood (d. 889), Yahya Ibn Ma’in (d. 233 AH/
847), Bukhari (d. 870), and Muslim (d. 875), among others (Tahtheeb Al
Kamal, 2004).

Hadith texts on homosexuality, some of which are eschatological in nature,
have the Prophet prescribe the death penalty for liwat, define liwat as
adultery, or portentously express concern on Muslims engaging in liwat.
However, even conservative Muslim scholars such as Shinqiti (2008) have
questioned the authenticity of these texts, specifically of those that have the
Prophet prescribe the death penalty for liwat. While a detailed analysis of
these texts is beyond the scope of this article, it is important to note that
these texts are not found in the more celebrated works of Bukhari and
Muslim because of the strong doubts that both these and other Hadith
authorities have raised on these texts.

Since Ahmed only quoted two sets of verses and a Hadith, analysis of other
verses and Hadith falls outside the scope of this article. While readers are
encouraged to explore works such as Kugle (2010) and Menyawi (2012), a
brief case for Muslim same-sex unions is delineated below as an alternative to
the prescription of permanent celibacy.

The case for Muslim same-sex unions

The analysis of the Qur’anic verses, Hadith texts, and rulings of the past
jurists indicates that the case for the prohibition of same-sex unions is not
reasonably justified. The prohibition of anal sex is not textually substantiated
and rests on the argument to prevent harm to the wife, a point confirmed by
the conditional permissibility of this act in Shii jurisprudence. The analysis of
the Qur’anic verses shows the stark difference between gays and lesbians and
the people of Lut, whose actions include inhospitality, ambushing travelers,
evil deeds in public assemblies, and forcibly accessing Lut’s guests. Texts
from the exegetical literature substantiate the point that Lut’s people sexually
subjugated males. The analysis of the Hadith texts indicates how terms such
as liwat are a product of later juristic thought, which further weaken the
credibility of these texts.

The rulings of the past jurists indicate that the reprehensibility of liwat is
based on extratextual assumptions that were informed by the sociocultural
mores and medical knowledge of those times. Specifically, liwat was viewed
in the context of beardless youth and men suffering from ubnah, a disease of
the anus, whose diagnosis is foreign to Islamic texts. Furthermore, liwat was
viewed as one-sided and one bereft of not only love and intimacy but also
from desire and pleasure. Past jurists viewed the desire to penetrate the anus
of a beardless boy or ma’bun (receptive partner suffering from disease) as
consistent with the desire to penetrate the vagina and therefore felt that
intercourse through marriage would be sufficient for those engaged in
liwat. They ruled on anal intercourse outside the folds of a legal contract
by males who could have satisfied their desires with women. However, the
question of a legal contract for same-sex couples has not been addressed in
Muslim jurisprudence.

In order to legitimize Muslim same-sex unions, the discourse has to be
shifted from one based on whims to indulge in liwat to one that acknowledges
the constitutional orientation of a minority of Muslims. Such an
orientation can be accepted on the basis of the fact that Muslim scholars
have accepted the inner constitution of the khuntha mushkil (intersex persons)
irrespective of external features. Acknowledging the exclusive orientation
of a minority group of Muslims, the definition of marriage as a legal
contract, and the juristic precedent of allowing for the marriage of the
khuntha mushkil substantiates the case for Muslim same-sex unions. This
case can be justified as an ijtihadi (independently reasoned) opinion through
the framework of maslaha (public interest) and the principle of raf al harj
(alleviating hardships), both of which are based on upholding human dignity
and justice. Indeed, the promotion of human dignity is an overriding objective
of the Sharia along with justice, equality, realization of lawful benefits for
people, prevention of harm, and removal of hardship (Kamali, 2005a, p. 166).
According to Menyawi (2012), past jurists were able to go against the grain
of their societies based on the principle of adl (justice) as opposed to explicit
Qur’anic backing, and jurists such as Tufi (d. 1316), Abduh (d. 1905), and Rida
(1935) advocated deriving rules even if they were not directly confirmed by the
texts. According to Tufi, if the rules derived from the nass (clear text) do not
uphold the good, then the texts have to be reinterpreted (Emon, 2010, p. 162).
Indeed, Ali noted how past jurists bypassed even clear Qur’anic verses based
on interpretive devices (Ali, 2006, p. xxi). Likewise, Kamali asserted that even if
no specific authority is found for the purpose of justification (Kamali, 2005b. p.
48), efforts for justice will always be in harmony with the Sharia (Kamali,
2005a, p. 174). Furthermore, he asserted that some jurisprudential rulings of
earlier times may now be deemed unjust due to a different set of circumstances
(Kamali, 2005a, p. 169, 175). According to Kamali, the legal maxim that ijtihad
(independent reasoning) is irrelevant in the presence of a nass should be
revised because of the possibility of fresh interpretation in a different context
(Kamali, 2005a, p. 158).

Since the Qur’an refers to marriage as mithaq ghaliz (firm covenant) in verse
4:21 (Menyawi, 2012), matrimonial laws fall in the category of muamalaat
(social transactions) (Kamali, 2005a, p. 151), which are subject to changes
based on changing social conditions. According to jurists of the Hanbali
school, one of the four in Sunni jurisprudence, in the absence of a clear text
that prohibits contracts, the normative position on contracts including marriage
is ibaha (permissibility); therefore, on the basis of Qur’anic verse 4:19,
which teaches that contracts be based on mutual consent, and given that
consent alone creates binding rights and responsibilities (Kamali, 2005a,
p. 162), the case for Muslim same-sex unions can be supported.

Muslim same-sex unions can be based on the values espoused by the Qur’an
on marriage. In verses 30:21 and 2:187, the Qur’an views marriage as forming
the basis of mawadda (affection), rahma (compassion), and as an institution
through which spouses find tranquility and companionship as they become a
libaas (protective garment) to each other, guarding their dignity and honor
(Kamali, n.d.). Such unions can also be supported on the basis of verse 9:71,
which depicts mutual protectorship of men and women, and verse 2:187,
which depicts cooperation and harmony between them (Ali, 2006, p. 183).
Thus, given that the Qur’an allows marriage for the purpose of contentment,
mawadda (affection), and compassion, and given that sterile couples and
elderly women are allowed to get married, there seem no reasonable grounds
to prohibit the realization of these benefits for same-sex couples.

In recent developments, Muslim academics Omid Safi and Mohammad
Fadel have expressed support for same-sex marriage in a secular North
American context. Safi expressed his support as follows:
I have seen these families show the same love, affection, and attention on their
children that my own heterosexual family does. Love is love. Family is family,
though they come in different shapes. My children have gay and lesbian friends.
They belong to a social club at school that is an alliance of straight, gay, lesbian,
and bi-sexual students. (Safi, 2013)
Likewise, in the context of the 2012 elections in the United States, Fadel
expressed:
We can support the idea of same-sex marriage because what we want is to make
sure that all citizens have access to the same kinds of public benefits that other
people do . . . Islamic law can at least qualify the endorsement of the idea, at least in
the context of democratic, non-religious states. (Jahangir, 2013, March 28)
In Indonesia, Siti Musdah Mulia and other Muslim scholars were reported
to have concluded that same-sex orientation was from God and that samesex
relationships were permissible in Islam (Khalik, 2008). Muslims for
Progressive Values (MPV) in the United States and Universalist Muslims in
Canada have come out in full support of same-sex unions. Pamela Taylor of
MPV stated that condemning gay Muslims to celibacy would go against the
“fundamental Islamic ideals of fairness, equality of all human beings, compassion
and mercy” (Jahangir, 2012). Progressive Muslims of varying theological
backgrounds have created spaces that are inclusive of LGBTQ
Muslims, such as the El Tawhid Juma Circle Unity Mosques, MPV Unity
mosques, and Inclusive Mosque Initiatives (Jahangir, 2013, March 13).

Concluding remarks

Ahmed passed a value judgment that young Muslim adults should not try to

make homosexual conduct compatible with Islam. He came to this conclusion
due to his understanding of the Muslim scriptures and his reading of the
scientific literature. Similar opinions continue to be upheld by conservative
Muslim professionals and leaders. Consequences of the intransigent opinions
of Muslim community leaders include the severe cognitive dissonance
experienced by Muslim gays and lesbians, as witnessed in online forums
where Muslims struggling with their sexual orientation and faith seek counsel.
Therefore, Ahmed’s approach, which holds currency among conservative
Muslim leaders, deserves to be thoroughly critiqued.

While mainstream psychiatrists reject reparative therapy, even practitioners
of reparative therapy concede the failure of their techniques in
changing sexual orientation. Eventually, reparative therapists, like Ahmed,
prescribe celibacy as the solution. However, permanent celibacy is a value
foreign to Islam and is rejected as a solution for Muslim gays and lesbians.
Furthermore, in contrast to Ahmed’s approach, homosexuality cannot be
associated with promiscuity, AIDS, mental health issues, and illicit sexual
intercourse. Moreover, it would be unreasonable to superimpose the framework
of liwat, defined as anal penetration of beardless youth, male slaves, or
those suffering from ubnah (incurable disease of the anus), onto Muslim gays
and lesbians. The two sets of verses and the Hadith quoted by Ahmed were
shown to posit no relevance for Muslim gays and lesbians. Finally, a brief
case for Muslim same-sex unions was delineated along with recent developments
in Muslim communities in support of Muslim gays and lesbians.

Given the innateness of sexual orientation, disavowal of celibacy, rejection
of analogies with adultery and promiscuity, the distinction between Lut’s
people and Muslim gays and lesbians, and given the richness of Muslim
jurisprudence, we invite Muslim scholars to dispassionately study the issue,
which has hitherto been addressed with erroneous assumptions and misinformation.
We invite them to investigate the issue on the basis of a higher
ethic based on the teachings of the Prophet. In this context, the Prophet’s
teachings can be paraphrased as “Do not harm and accept no harm,” “Wish
for your brother what you wish for yourself,” “When some Muslims hurt
other Muslims ache,” “Facilitate, do not cause difficulties or cause people to
detest the law,” and “Do not fall into extremities but seek the middle path.”

Acknowledgments

Our opinions do not necessarily reflect the opinions or policies of our respective institutions
where we work. We are extremely grateful to Ayman H. Fadel for his excellent help with this
work.

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