LebMASH discusses mental health with victims of violence against women

On Jan. 9th 2014, the Lebanese Medical Association for Sexual Health provided an educational session about depression and some of its features in the female gender to women from KAFA (Enough Violence and Exploitation), an NGO aiming at fighting gender based violence and advocating for women’s rights in Lebanon and the Middle East.

The presentation was an interactive one where most of the participants talked about their own experience with depression. Symptoms of depression were explained, as well as the difference with transient sad mood. The presentation also dealt with the etiologies of depression, and the risk factors especially in the post-partum period.

Another section of the presentation was about management of depression, and the participants had many questions about antidepressants and tranquilizers: difference between them, delay of action, side effects, duration of treatment. Other aspects of depression management were also explained, with an emphasis on psycho-social support.

Finally, a video was shown to the participant about symptoms and management of depression, made by the WHO, and available online: http://www.youtube.com/watch?v=d4ccGUeP3aY.

Dr. Hala Kerbage - Psychiatrist LebMASH partner

Dr. Hala Kerbage – Psychiatrist – LebMASH partner

Break the Silence 2014 – $1,500 for 1,500 words

The Lebanese Medical Association for Sexual Health (LebMASH) calls on students in any medical field who are interested in sexual health and LGBT (Lesbian, Gay, Bisexual and Transgendered) health to apply for the second annual Break the Silenceacademic paper competition.

LebMASH Break The Silence competition

Students are invited to:

  1. Write an academic quality paper of a maximum of 1500 words on any issue related to either women’s sexual health or LGBT health in Lebanon.
  2. Submit the paper along with a CV and contact info to: info@lebmash.org

The deadline for submissions is Friday June 20, 2014 at midnight. 

At the end of the competition, LebMASH executive board members will review all submissions and select one winner who will be granted a trip (Up to max of  1500 USD) to Baltimore, Maryland, USA to attend GLMA’s (Health Professionals Advancing LGBT Equality) annual conference that will take a place from Sep 10 to 13, 2014.

GLMA annual conference

LebMASH will help the student publish her/his work in a peer-reviewed medical journal. LebMASH will also publish a French and Arabic translation of the winning paper on lebmash.org.

Break The Silence Competition LebMASH

LebMASH speaks depression with queer Syrian refugees

The Lebanese Medical Association for Sexual Health LebMASH gave a presentation on Monday the 3rd of February 2014 about depression and its management to a group of non-heterosexual Syrian refugees part of the Whispers Project by Proud Lebanon, a relatively new non-governemental organization. 

The presentation was interactive where most of the participants talked about their own experience with depression. Symptoms of depression were explained, especially how it differs from transient sad mood. The presentation also dealt with the etiologies of depression, and the risk factors, especially the environmental stressors, and the history of trauma or the exposure to political violence and oppression.

Another section of the presentation was about management of depression, and the participants had many questions about antidepressants and tranquilizers: difference between them, delay of action, side effects, duration of treatment, risk of addiction.  Other aspects of depression management were also explained, with an emphasis on psycho-social support.

A big thanks to our own Dr. Hala Kerbage, a LebMASH Partner, who conducted the session and wrote the above briefing. Thanks to Proud Lebanon for taking such an initiative to educate GBT Syrian refugees about sexual and mental health among other services they provide.

Proud Lebanon organization - LebMASH

A glimpse of our work in 2013, published

Dr. Hasan Abdessamad Obstetrician Gynecologist OBGYN Vancouver

Dr. Hasan Abdessamad

Dr. Omar Fattal Psychiatrist New York

Dr. Omar Fattal

Dr. Hasan Abdessamad (LebMASH president) and Dr. Omar Fattal (LebMASH treasurer) just published an article in LGBT Health peer-reviewed medical journal about the work we have done in Lebanon in 2013.

The article has been been published online “Ahead of Print” to be viewed publicly. Here is the full length of the article:

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.”1 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.2

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.3 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.4 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.5

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.6

Forensic physicians are known to perform anal tests that involve the insertion of an egg-shaped object into the person’s 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.7 The incident stirred outrage from several human rights groups. HRW published a report in August 2012 titled, “Lebanon: Stop ‘Tests of Shame.’”8 This outrage resulted in the Lebanese Order of Physicians issuing a strong statement condemning this practice.9

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 (Lebanon’s largest LGBT rights organization). Mental health professionals have spoken favorably about such practices publicly on TV.10

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 Health’s 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.1112

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). LebMASH’s 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.10
LebMASH also published a position statement on SOCE on May 17, 2013, to correct misconceptions regarding homosexuality.13 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.14 This activity falls under LebMASH’s 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 2013.1516 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.17 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, LebMASH’s 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.

References

  1. P Healy: Beirut, the Provincetown of the Middle East. The New York Times. July 29, 2009. Available athttp://travel.nytimes.com/2009/08/02/travel/02gaybeirut.html (last accessed on Nov. 11, 2013).
  2. 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).
  3. A Awadalla: Lebanon—inflammatory TV show leads to arrests of gay men. The Global Voices. August 1, 2012. Available at http://globalvoicesonline.org/2012/08/01/lebanon-inflammatory-tv-show-leads-to-arrests-of-gay-men(last accessed on Nov. 11, 2013).
  4. J Ayoub: Lebanese police arrest four during gay club raid. The Global Voices. May 8, 2013. Available at http://globalvoicesonline.org/2013/05/08/lebanon-scandal-breaks-out-over-homophobic-raid-in-dekwaneh (last accessed on Nov. 11, 2013).
  5. Human Rights Watch: Lebanon—police torturing vulnerable people. June 26, 2013. Available atwww.hrw.org/news/2013/06/26/lebanon-police-torturing-vulnerable-people (last accessed on Nov. 11, 2013).
  6. F Elkak: Homophobia in clinical services in Lebanon, a physician survey. Helem. February 8, 2010. Available athttp://helem.net/sites/default/files/HELEMStudies_MroueKak_0.pdf (last accessed on Nov. 11, 2013).
  7. BBC World News: Outraged Lebanese demand end to anal exams on gay men. August 7, 2012. Available atwww.bbc.co.uk/news/world-middle-east-19166156 (last accessed on Nov. 11, 2013).
  8. Human Rights Watch: Lebanon: Stop “tests of shame.” August 10, 2012. Available atwww.hrw.org/news/2012/08/10/lebanon-stop-tests-shame (last accessed on Nov. 11, 2013).
  9. Russia Times: Test of shame! Lebanese protest against anal probe for suspected gays. August 11, 2012. Available at http://rt.com/news/homosexuality-anal-test-protest-lebanon-445 (last accessed on Nov. 11, 2013).
  10. Lebanese Medical Association for Sexual Health: Response to Dr. Khoury’s interview about homosexuality. June 24, 2013. Available at http://lebmash.wordpress.com/2013/06/24/pr2-en (last accessed on Nov. 11, 2013).
  11. J Tohme: MSM in Lebanon: A look at current HIV prevention and sexual health initiatives. The Global Forum on MSM & HIV. November 4, 2013. Available at http://msmgf-blog.blogspot.ca/2013/11/a-look-at-hiv-prevention-and-sexual.html (last accessed on Nov. 11, 2013).
  12. Marsa Sexual Health Center website. Available at http://marsa.me (last accessed on Nov. 11, 2013).
  13. 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).
  14. A Shidlo, M Schroeder: Changing sexual orientation: A consumers’ report. Prof Psychol Res Pract2002;33:249–259.
  15. 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).
  16. 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).
  17. Lebanese Medical Association for Sexual Health: LebMASH sponsors medical student’s trip to Denver USA. July 17, 2013. Available at http://lebmash.wordpress.com/2013/07/17/bts-en (retrieved on Nov. 11, 2013).

To cite this article:

Abdessamad HM, Fattal O. Lebanese Medical Association for Sexual Health: Advancing Lesbian, Gay, Bisexual, and Transgender Health in Lebanon. LGBT Health. 2014 Jan. ahead of print. doi:10.1089/lgbt.2013.0039.

Educational session about anal health

  • إقرأ بالعربية هنا
  • En Français ici

The Lebanese Medical Association for Sexual Health gave a presentation on Friday the 2nd of December 2013 about anal health to the Whispers project that attends to the needs of non-heterosexual Syrian refugees in Lebanon.

The presentation dealt with topics related to the sexual health of the anus. One of the main topics was the use of enemas before anal intercourse with a focus on its proper use and risks of misuse.

The presentation also dealt with the importance of using water-based lube in sexual intercourse to avoid some anal problems such as anal fissures. Sexually transmissible infections related to the anal region were discussed with a focus on HIV and  Hepatitis B.

The presentation was followed by a Q&A session and a discussion about safer ways of having anal intercourse.

Graciously translated by LebMASH volunteer translator: Patrick

Dr. Omar Harfouch - Anal Health session LebMASH

شرّج معلوماتك عن الشرج

  • Read in English here
  • En Français ici

قدّمت الجمعيّة اللّبنانيّة الطبيّة للصحّة الجنسيّة  نهار الجمعة الواقع في 2 كانون الأوّل 2013 محاضرة بعنوان “شرّج معلوماتك عن الشرج” لمجموعة ويسبرز الّتي تعنى بالمثليين اللّاجئين السوريّين

وتناول العرض مواضيع متعلّقة بالصحّة الجنسيّة للشرج. ومن أبرز المواضيع كان موضوع الحقن الشرجيّة التّي يستعملها الرّجال ذو العلاقات الجنسيّة مع الرّجال قبل العلاقات الجنسيّة الشرجيّة. وتمّ التركيز في هذا الموضوع عن خطورة هذه الحقن على الشّرج والجهاز الهضمي في حال تمّ استعمالها بكثرة أو بطريقة غير صحيحة

وتناول العرض أيضاً أهميّة استعمال المرطّب المائيّ في العلاقات الجنسيّة لتجنّب العديد من المشاكل الشرجيّة منها الشقّ الشرجيّ. ثمّ تمّ مناقشة الالتهابات الجنسيّة التّي تضرّ الشرج من التواليل وغيرها، اضافةً الى شرح مفصّل عن كون الشرج أكثر عرضة لجميع الاتهابات المنقولة جنسيّاً وبالأخصّ فيروس نقص المناعة البشريّ وفيروس التهاب الكبد ب وس

وتلى العرض جلسة أشئلة وأجوبة ونقاش حول الطّرق الامنة لممارسة الجنس الشرجيّ

Dr. Omar Harfouch - Anal Health session LebMASH

Saisis plus d’informations concernant ta voie anale

  • إقرأ بالعربية هنا
  • Read in English here

L’Association libanaise de la santé sexuelle a réalisé le lundi 2 décembre 2013 un colloque intitulé : ‘Saisis plus d’informations concernant ta voie anale’. Ceci était  présenté par le groupe de Whisper qui traite les problèmes des  réfugiés syriens homosexuels.

Le colloque a discuté  la présentation des thèmes liés à la santé sexuelle de l’anus. L’un des plus importants thèmes était  les lavages utilisés par les homosexuels avant la relation sexuelle anale. L’accent a été mis sur l’importance de ces injections et leur influence sur  le système digestif et anal au cas où c’était utilisé excessivement ou mal utilisé.

En outre, la Présentation a expliqué l’importance de l’utilisation de l’eau hydratante durant les relations sexuelles pour éviter pleins de problèmes y compris les fissures anales.

Ils ont examiné aussi les infections sexuelles anales touchant les verrues et autres, en plus  d’une explication détaillée du fait que l’anus est plus vulnérable à toutes infections  transférées sexuellement notamment le  VIH et l’hépatite b. L’affichage a suivi des questions et réponses et une discussion des façons sécuritaires pour pratiquer une vie sexuelle prudente.

Graciously translated by LebMASH volunteer translator: Charbel

Dr. Omar Harfouch - Anal Health session LebMASH

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