When was the last time your doctor talked to you about your sexual health? When was the last time you asked your doctor about the quality and health of your sex life? I practice psychiatry, and although my focus is on mental health, physical health, including sexual health, is an integral part of the discussions I have with my patients. Even better, many of my patients ask me questions about their sexual health, as they consider it an integral part of their overall health and wellbeing.
In Lebanon, talking about sexual health has been muffled, if not muted, for far too long. It could be due to a lack of clear government policy or because of inconsistent funding from donors. Or it could be that political, social and economic issues have led to sexual health being forgotten altogether. Or maybe it is just the “sex” part of sexual health. After all, merely bringing up sexual health can be taboo, because it means that we have to acknowledge that sex exists.
Personally, my goal is not to break taboos or address moral issues. Nor do I want to dwell on discrimination and marginalization in Lebanon, pervasive as these can be. I am a medical doctor, looking to advance a conversation on a health issue.
As a physician, I try to take an ethical and compassionate approach based on three premises: (1) sexual health is an integral part of health and wellbeing; (2) health is a human right that should be enjoyed by everyone; and (3) my duty as medical doctor is to advocate for the right to accessible, respectful and quality healthcare services, including those services falling under sexual health services.
People have the right to health, including sexual health, regardless of their nationality, sex, ethnicity, religious background, socioeconomic status, sexual orientation or gender identity. And while this is my personal and professional opinion, by affirming the right to health and sexual health, I am not introducing a revolutionary idea. These rights have been affirmed by the United Nations for many years.(1)
My concern is that while ignoring sexual health affects everyone, it may disproportionately impact women and sexual minorities, such as lesbian, gay, bisexual and transgender (LGBT) individuals. After all, these marginalized groups and individuals targeted by discrimination already tend to suffer worse health outcomes, especially when it comes to sexually transmitted infections, HIV and mental health outcomes(2)(3)(4). They are exactly the kind of individuals whose needs must not be ignored
Concerned about the above issues, I decided to join a group of healthcare professionals from Lebanon to found the Lebanese Medical Association for Sexual Health (LebMASH) in 2012. Our goal is to advance the sexual health and wellbeing of all people in Lebanon, particularly marginalized populations. In accordance with our mission, we have worked on addressing the gaps related to the health of sexual minorities in Lebanon, including LGBT individuals. Our work over the past few years has included awareness projects, educational projects for health care professionals, promoting research on sexual health, and creating an LGBT health curriculum.
While comprehensive health promotion requires the involvement of key players, such as the policy makers, academic institutions, research centers, and the community itself, we realize that we cannot sit still, in the absence of a clear government policy for addressing the sexual health needs of the population. We have learned that, partnering with academic centers, other healthcare professional organizations, and other members of the civil society, we can take steps in a positive direction. For example, LebMASH has worked closely with the Lebanese Psychiatric Society and the Lebanese Psychological Association to issue clear position statements in May 2013, affirming that homosexuality is not a disease and does not require treatment. In 2015, we have partnered with Johns Hopkins Bloomberg School of Public Health to develop a culturally- applicable, evidence-based curriculum for medical students that focuses on sexual health and LGBT health. Over the past few years, we have worked closely with universities in Lebanon to conduct workshops and lectures with medical students and other healthcare students on the topics of sexual health, mental health and the health of sexual minorities. Earlier this year, we released an education video called “Shu el sabab” dispelling medical misconceptions about homosexuality.(5)
One can hope for a Lebanese health system that is more comprehensive, taking into consideration the needs of women and sexual minorities. That might take several years, but it is no reason to despair or feel helpless. In fact, in 2015 the Lebanese Ministry of Public Health has included LGBT people under “vulnerable groups” in their National Mental Health Strategy(6). I believe the acknowledgement of the health needs of LGBT people is significant first step towards a more inclusive public health policy.
Meanwhile, we need to start having a more honest conversation about the value of sexual health to our overall health and wellbeing. We also need to educate ourselves about how we fare in this area and on the work being done to advance sexual health in Lebanon.
There is certainly a lot to be done, but here is also a lot being done. Civil society and healthcare organizations have been taking the lead, and we will continue to work together to advocate for health rights in Lebanon. The road is long ahead and full of challenges but also potential rewards. At LebMASH, we have decided to take on these challenges and we are very excited about the future of sexual health in Lebanon. Will you join us? Let’s start by talking about sexual health.
- International Covenant on Economic, Social and Cultural Rights. CESCR General Comment No. 14: The Right to the Highest Attainable Standard of Health (Art. 12). Office of the Higher Commission for Human Rights. Adopted at the Twenty-second Session of the Committee on Economic, Social and Cultural Rights, on 11 August 2000 (Contained in Document E/C.12/2000/4)
- Schwartz, S. R., Nowak, R. G., Orazulike, I., Keshinro, B., Ake, J., Kennedy, S., … & TRUST Study Group. (2015). The immediate effect of the Same-Sex Marriage Prohibition Act on stigma, discrimination, and engagement on HIV prevention and treatment services in men who have sex with men in Nigeria: analysis of prospective data from the TRUST cohort.The Lancet HIV, 2(7), e299-e306.
- Baral, S., Trapence, G., Motimedi, F., Umar, E., Iipinge, S., Dausab, F., & Beyrer, C. (2009). HIV prevalence, risks for HIV infection, and human rights among men who have sex with men (MSM) in Malawi, Namibia, and Botswana. PloS one, 4(3), e4997.
- Baral, S., Sifakis, F., Cleghorn, F., & Beyrer, C. (2007). Elevated risk for HIV infection among men who have sex with men in low-and middle-income countries 2000–2006: a systematic review.PLoS Med, 4(12), e339.
- www.lebmash.org/ ما-بهم-شو-السبب،-المثليّة-منّا-مرض-shu-el-sabab/
- Health Response Strategy, A New Approach in 2015 & Beyond, Ministry of Public Health, July 2015,http://www.moph.gov.lb/AboutUs/strategicplans/Documents/MOPH%20Health%20Response%20Strategy-2015.pdf