Category: Position Statements

Summary:

In 2012, an initial partial ban on anal testing was issued. However, there were multiple reports that showed that anal testing continued to take place despite the ban. LebMASH played a significant role in cementing the ban on anal testing in 2014 through raising public awareness on the issue and lobbying with the Lebanese Order of Physicians and putting pressure on the Lebanese government.

Timeline

2012
Human Rights Watch brings attention to the issue:

The head of the Lebanese Doctor’s Syndicate, Dr. Sharaf Abu Sharaf, issued a directive on August 8, 2012 calling for an end to anal examinations, stating that they are medically and scientifically useless in determining whether consensual anal sex has taken place and that they constitute a form of torture. He added that they also violate article 30 of the Lebanese law on medical ethics, which prohibits doctors from engaging in harmful practices.

The tests also violate international standards against torture, including the Convention Against Torture and the International Covenant on Civil and Political Rights, which Lebanon has ratified. The U.N. Committee Against Torture, in its 2002 review of Egypt, investigated the issue of forensic anal examinations and called on the government “to prevent all degrading treatment on the occasion of body searches.”

In a statement given to the Lebanese daily Al-Akhbar on August 2, Justice Minister Shakib Qortbawi said that he had two months earlier written Attorney General Said Mirza urging him “to halt random rectal examination procedures, after the issue was raised by human rights organizations.” However, the attorney general’s subsequent directive, the text of which Legal Agenda, a Lebanese rights organization, published on August 7, contradicts the Minister’s statement to Al-Akhbar.

Far from ordering an end to the procedures, the attorney general’s directive in fact institutionalized them further, instructing public prosecutors to order the anal examination be carried out only “with the consent of the accused, according to standard medical procedures, and in a manner that does not cause significant harm.” The directive added that if the accused refused to undergo the examination, he should be informed that his refusal “constitutes proof of the crime.”

July 2014
Legal Agenda reports that anal tests are still happening

July 2014
LebMASH releases position statement on anal tests.

Aug 2014
LebMASH meets with LOP president Dr. Boustani to voice concerns over anal tests and urge LOP to reaffirm its position on banning anal tests and ensure that forensic doctors are not allowed to perform these test.

LebMASH offered to conduct sensitivity training workshops to Forensic doctors to explain the harms of anal testing.
For more info, click here.

October 2014
LebMASH sends a letter to Prime Minister Tamam Salam to urge him to put an end to anal tests. For more info, click here.

No further anal testing reported after that in Lebanon. 

Over 2,400 people living with HIV infection are estimated to live in Lebanon (1). Stigma and discrimination towards this population, as a consequence of their HIV status, result in significant negative consequences on their health and wellbeing (2) (3) (4). These issues affect a lot of people living with HIV in Lebanon and play an important obstacle for HIV treatment and prevention in Lebanon today.

Stigma towards people with HIV in Lebanon exists for a number of reasons. Inaccurate information regarding HIV transmission fosters irrational beliefs and behaviours, resulting in a poor perception of personal risk (4). HIV continues to be associated with societal taboos such as sex work, illicit intravenous drug use, and in particular, homosexuality. Negative attitudes towards homosexuality are common in much of the Lebanese society. Furthermore, men who have sex with men (MSMs) account for over half of cases of recent HIV infection in Lebanon (5). Legal discrimination as well as harassment and violence against gay men and transwomen is known to deem these groups more vulnerable worldwide. Article 534 of the Lebanese Penal code, which criminalizes sexual acts “contrary to nature” along with recent arrests and harassment of gay men in the country also deters potentially play a similar role in Lebanon and prevent also deters many MSMs from seeking HIV testing and treatment as they fear legal repercussions as a result of disclosing their sexual behaviours to health workers (6). Additionally, the World Health Organisation, for example, states that fear of discrimination and stigma is the principal reason deterring individuals from getting tested, disclosing their HIV status and taking antiretroviral therapy (7). Information on the infection of transwomen with HIV is not included in data that is presented by the National AIDS program in Lebanon.

Access to healthcare for people living with HIV in Lebanon poses a considerable challenge. Whereas anti-retroviral medications and HIV testing may be obtained free of charge, significant barriers exist to obtaining long-term HIV treatment (6). Patients who test positive for HIV fear that their diagnosis will not remain confidential and thus that this diagnosis will have profound negative implications for other areas of their life (2). Case reports exist of individuals who lost their medical insurance and job as a result of their HIV diagnosis (8). The stigma associated with the virus increases further the fear of individuals who test positive for HIV of seeking treatment or even having it in their households.

Sexual education is missing in all health related curricula in Lebanon and health care workers rarely discuss sexual concerns with clients. As a result, stigma against people with HIV is also common amongst health workers. Such stigma includes avoiding patients with HIV, refusing to treat them, breaking their confidentiality or indeed treating them with any less care or concern than any other patients. In many cases, these behaviours are complicated by discriminatory attitudes and actions towards HIV+ patients who are LGBT+, drug-users or of foreign origin. Such beliefs act as a further deterrent to health care access, worsening these patients’ health and wellbeing.

On World AIDS Day 2016, the Lebanese Medical Association for Sexual Health calls for:

• Better documentation of people living with HIV in order to make sure interventions are affecting people who need it the most. Particularly LebMASH calls on including transgender populations in national HIV data presented.
• Better education about HIV targeting health providers, the broad public and government workers.

While LebMASH salutes the efforts that sister organizations are doing in the field, wWe renew our commitment commend better efforts to:

• Increase education among health workers and the general public on the virus and how it affects specific vulnerable groups
• Further research and understand the epidemic in Lebanon and how to face it from a social and medical stand-point.
• Advocate for implementation of accurate treatment and prevention guidelines, particularly when it relates to treatment as prevention with treatment ensured to anyone living with HIV to both increase their longevity as well as prevent the transmission of the virus.

Bibliography

1. UN AIDS Report Lebanon. United Nations. 2016, p. http://www.unaids.org/en/regionscountries/countries/lebanon/ .
2. Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis. Katz, I.T. et al (2013) ‘’. 2013, JIAS 16, p. (Supplement 2) : 18640 .
3. (2009) ‘HIV-related stigma and psychological distress: the harmful effects of specific stigma manifestations in various social settings. Stutterheim, S.E. et al. 2009, AIDS, p. 23:17.
4. Combating HIV/AIDS-related Stigma in Egypt: Situation Analysis and Advocacy Recommendations. Egyptian Anti-Stigma Forum. 2012.
5. Are HIV Epidemics among Men Who Have Sex with Men Emerging in the Middle East and North Africa?: A Systematic Review and Data Synthesis. Mumtaz G, Hilmi N, McFarland W, Kaplan RL, Akala FA, et al. 2011, PLoS Med , p. 8(8): e1000444.
6. A Qualitative Exploration of Sexual Risk and HIV Testing Behaviors among Men Who Have Sex with Men in Beirut, Lebanon. Wagner GJ, Aunon FM, Kaplan RL, Rana Y, Khouri D, et al. 2012, PLoS ONE, p. 7(9):e45566.
7. Global HIV/AIDS Response: Epidemic update and health sector progress towards Universal Access: Progress report 2011. World Health Organisation. 2011.
8. Can Lebanon’s new plan end stigma of HIV/AIDS? Kullab, Samya. 2015, Al Jazeera, pp. http://www.aljazeera.com/news/2015/12/lebanon-plan-stigma-hivaids-151202083548675.html.