Kirsty Clark, a Masters of Public Health candidate at the Yale School of Public Health, spent May July 2015 in Beirut, Lebanon conducting research on how sexual stigma against women in Lebanon influences sexual healthcare. Kirsty conducted 21 interviews with NGO workers and physicians in the field of sexual health.
Here is the abstract of the study, the full publication is in press:
Research and reporting surrounding women’s sexual health in Lebanon is scarce. There is currently no reliable data on rates of sexually transmitted infections (STIs), level of sexual health knowledge, or information regarding access points of sexual health care among women. Using individual semi-structured qualitative interviews, investigators conducted formative research to gain a deeper understanding of sexual health among women in Lebanon. Using multiple purposive and snowball sampling strategies, 21 key informants were recruited from a number of regions in Lebanon. 11 of the key informants are physicians (OBGYNs and Infectious Disease) and 9 are staff (non-physicians) at STI/HIV Voluntary Testing and Counseling (VCT) centers. Findings suggest that sexual stigma against women acts insidiously at each level of the social-ecological model (internalized, relationship with healthcare providers, community/family, and societal) to inhibit women’s knowledge and access surrounding sexual health care. Findings can be utilized to inform sexual health interventions and as foundation for further research.
Hasan M. Abdessamad, MD, FRCSC, FACOG, and Omar Fattal, MD, MPH
Abstract
Lebanon is considered relatively liberal, but Lebanese lesbian, gay, bisexual, and transgender (LGBT) individuals continue to face social and legal challenges. Homophobia is common among health-care providers. Only 50% of physicians in a study were willing to “tend the medical needs” of homosexuals. Homosexuality is still perceived as a disease and the practice of reparative therapy is common. Programs focusing on sexual health are scarce, with only a few being LGBT-friendly. For Lebanese LGBT individuals, there remains a significant gap in access to health care. The Lebanese Medical Association for Sexual Health (LebMASH) was established to address this gap.
Introduction
In the past several years, we have noticed a trend in the West that depicts Lebanon as a gay-friendly destination. For example, The New York Times published an article in 2009 titled, “Beirut, the Provincetown of the Middle East.” In reality, even though Lebanon is more liberal than other Arab countries when it comes to lesbian, gay, bisexual, and transgender (LGBT) rights, Lebanese LGBT individuals face significant social and legal challenges.
Article 534 of the Lebanese penal code states: “Any sexual intercourse contrary to the order of nature is punished by imprisonment for up to one year.” This article has been widely used in recent years to criminalize a variety of consensual male and female homosexual relationships. It has also been widely used to blackmail and intimidate LGBT individuals.
Personal status and matters related to family law are under the jurisdiction of the religious court system. Christianity and Islam, the two biggest religions in Lebanon, have a large influence on the fabric of the society.
In general, homosexuality remains a social taboo, and in the past decade, Lebanon has witnessed a crackdown on the LGBT community. For instance, in July 2012, 36 individuals were arrested in a movie theater that caters to the clientele of men who have sex with men (MSM) in Beirut. In April 2013, a popular gay nightclub in a Beirut suburb was shut down by the local municipality. Several people were arrested and exposed to verbal, physical, and sexual abuse. Nude photographs of detainees were leaked to social media. In June 2013, Human Rights Watch (HRW) released a report detailing the ill treatment of vulnerable populations, including LGBT individuals, by Lebanese internal security forces.
These legal, social, and religious factors create a climate of fear and intimidation with several negative outcomes such as hindering LGBT individuals from coming out to friends and family as well as to their health-care providers.
Background on LGBT Health
The literature on LGBT health in Lebanon is very scarce. In a study that was conducted in 2010, 73% of surveyed physicians believed that homosexuality is a disease and only 50% were willing to “tend the medical needs” of a homosexual patient.
Forensic physicians are known to perform anal tests that involve the insertion of an egg-shaped object into the persons anus to ascertain if someone is homosexual.This practice came to light on a large scale after the movie theater arrests in 2012 when 36 detainees were subjected to the test. The incident stirred outrage from several human rights groups. HRW published a report in August 2012 titled, “Lebanon: Stop ‘Tests of Shame.’” This outrage resulted in the Lebanese Order of Physicians issuing a strong statement condemning this practice.
Furthermore, sexual orientation change efforts (SOCE) are still prevalent in Lebanon. There have been several verbal reports about the so-called Reparative or Conversion Therapy to Helem (Lebanons largest LGBT rights organization). Mental health professionals have spoken favorably about such practices publicly on TV.
The past decade has witnessed a few efforts to improve LGBT health, although catered more toward MSM. These efforts mainly represent the work done by Helem, Soins Infirmiers et Dèveloppement Communautaire, and the Ministry of Healths National AIDS Program to tackle HIV infection.11 In addition, Marsa was established in early 2011 as the first sexual health center in Lebanon. Marsa provides voluntary counseling and testing for HIV and comprehensive primary and secondary health-care services in an LGBT-affirmative environment.
Lebanese Medical Association for Sexual Health
Despite these efforts, the gap in access to health care for LGBT individuals in Lebanon remains very large. A group of Lebanese health-care professionals came together in September 2012 to create the Lebanese Medical Association for Sexual Health (LebMASH). LebMASHs mission is to advance health care for LGBT individuals and sexual health for all individuals in Lebanon. LebMASH has the following objectives:
• Spreading awareness and knowledge, as well as influencing attitudes and behaviors of health-care providers and the general public regarding LGBT health and sexual health
• Influencing and changing policies and legislations in professional organizations, including schools, hospitals, and governmental agencies, to protect the health rights and well-being of LGBT individuals and sexual health of the general public
• Advancing research regarding LGBT and sexual health
• Supporting other organizations that provide health care to LGBT individuals and sexual health care
In the past year, LebMASH had several activities that fall under the following categories:
• Raising awareness
• Education
• Advancing research
• Advocacy
• Encouraging professional development
Under the category of raising awareness, LebMASH has been vigilant in monitoring the Lebanese media for any appearances or reports that present inaccurate information on sexual or LGBT health. In June 2013, LebMASH published a reply to a pseudopsychologist who appeared in an interview on a major TV station and was noted to give wrong information on homosexuality.
LebMASH also published a position statement on SOCE on May 17, 2013, to correct misconceptions regarding homosexuality.The statement urged “health care providers in Lebanon to refrain from this [SOCE] unethical and potentially harmful practice,” and called on “health care organizations to take a strong position against such practices.”
Under the category of education, one LebMASH board member gave a lecture about LGBT health to second-year medical students at the American University of Beirut in late 2012. This was the first time medical students receive such a lecture. The same author gave a Q&A Skype session about transgender health with 11th-grade students at the Dubai British School in February 2013.
Under research activities, LebMASH actively seeks funding to examine trauma in LGBT refugees in Lebanon. Currently, LebMASH is working on translating to Arabic a landmark study that was published by Shidlo and Schroeder in 2002 on reparative therapy. This activity falls under LebMASHs commitment to making more scientific literature available in Arabic. LebMASH established the annual “Break the Silence” research award for students. The 2013 award went to a medical student who wrote an article on hymenoplasty. LebMASH has served as a consultant on a research project on perception of discrimination by LGBT people in the health-care system in Lebanon.
Under the category of advocacy, LebMASH worked closely with the Lebanese Psychiatric Society and the Lebanese Psychological Association to come out with historic position statements about homosexuality in May 2013.These statements, the first of their kind in the Arab world, reaffirmed that homosexuality is not a disease and does not require any treatment. The statements also stressed the health risks of SOCE. These statements were widely discussed in national and international media.
Under the category of professional development, LebMASH sponsored a medical student in 2012 and another one in 2013 to travel to the United States to attend the annual conference of the Gay and Lesbian Medical Association: Health Professionals Advancing LGBT Equality. Attending such meetings brings international experience to students in Lebanon and diversifies their training and exposure.
In its first year of existence, LebMASH has faced several challenges. The first challenge was related to language. Arabic is the official language in Lebanon, which necessitates making all content available in or translated to Arabic to reach the general public. In addition, medical schools in Lebanon use either English or French language solely; therefore, it is important to provide all content in these two languages as well for a wider reach within the medical community. Using three languages is time-consuming and costly.
Second, LebMASHs executive board has members who are based in Lebanon, the United States, and Canada. Even though this can be viewed as an asset especially when it comes to networking, resources, international reach, and experience, it presents a burden when board meetings or events need to be arranged. Finally, the political instability in the region makes people less concerned about health in general and sexual health in particular, and more concerned with issues of security.
Moving forward, LebMASH will continue to strengthen and expand its activities in the major areas outlined above: awareness, education, research, advocacy, and professional development. Also, LebMASH aspires to represent Lebanon at the international level on issues relating to LGBT and sexual health.
Conclusion
The past decade in Lebanon has witnessed some advances on the legal and social fronts for LGBT individuals; however, the health front has seen only minimal advances. LGBT individuals continue to face major barriers on multiple levels, and the gap in LGBT health remains very significant. LebMASH was established to address this gap, and during its first year of existence, it has proven to be a promising model for advancing LGBT health in difficult environments in which LGBT individuals lack civil protections.
N Saghiyeh, W Al-Farchich: Homosexual relations in the penal codes: General study regarding the laws in the Arab countries with a report on Lebanon and Tunisia. Helem. October 2009. Available at http://helem.net/node/53 (last accessed on Nov. 11, 2013).
Lebanese Medical Association for Sexual Health: Response to Dr. Khourys interview about homosexuality. June 24, 2013. Available at http://lebmash.wordpress.com/2013/06/24/pr2-en (last accessed on Nov. 11, 2013).
Marsa Sexual Health Center website. Available at http://marsa.me (last accessed on Nov. 11, 2013).
Lebanese Medical Association for Sexual Health: Position statement on sexual orientation change efforts (SOCE). May 17, 2013. Available at http://lebmash.wordpress.com/2013/05/17/ps1-en (last accessed on Nov. 11, 2013).
A Shidlo, M Schroeder: Changing sexual orientation: A consumers report. Prof Psychol Res Pract2002;33:249–259.
Lebanese Medical Association for Sexual Health: Lebanese Psychiatric Society: Homosexuality is not a disease. July 12, 2013. Available at http://lebmash.wordpress.com/2013/07/12/lps-en (last accessed on Nov. 11, 2013).
Lebanese Medical Association for Sexual Health. Third Lebanese Medical Group to denounce conversion therapy. July 18, 2013. Available at http://lebmash.wordpress.com/2013/07/18/lpa-en (last accessed on Nov. 11, 2013).
Lebanese Medical Association for Sexual Health: LebMASH sponsors medical students trip to Denver USA. July 17, 2013. Available at http://lebmash.wordpress.com/2013/07/17/bts-en (retrieved on Nov. 11, 2013).
