Response to Dr. Khoury’s interview about homosexuality

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The Lebanese Medical Association for Sexual Health (LebMASH), in response to the interview conducted with Dr. Nabil Khoury by OTV on June 6^th, 2013 would like to clarify the following:

The use of the terms “louti” (derogatory Arabic slang for gay) and “sou7ak” (derogatory Arabic slang for lesbian) is offensive and further alienates lesbian and gay individuals in Lebanon.

We call on all health care professionals in Lebanon to refrain from using such terms. The terms milthi (gay) and mithliyya (lesbian) are the appropriate, non-judgmental terms to use when discussing members of the gay and lesbian community. It is our duty as health care providers to help people attain healthier lives. Using derogatory terms to describe a group of individuals in our society fuels the abuse, bullying, prejudice, and discrimination to which this group is already subjected to and leads to worse health in these individuals. (1)

We agree with Dr. Khoury regarding the lack of association between secondary sexual characteristics and sexual orientation. A masculine man can be sexually attracted to other men and a feminine woman can be sexually attracted to other women.

Dr. Khoury disregards the current and evidence-based knowledge science provides us about homosexuality. Instead, he discusses different views that, in his opinion, explain homosexual tendencies. According to Dr. Khoury:

1. The first view considers homosexuality pathological and secondary to hormonal imbalances.
2. The second view is that of the church and Islamic Sharia which considers homosexuality abnormal and sees homosexuals as sinners.
3. The third view is about triggering factors that can “cause” homosexuality such as over- and under-affection, sexual abuse, using feminine pronouns for boys and masculine pronouns for girls, and “negativity” that can lead to attention-seeking behavior. Dr. Khoury claims that “the most important factor that leads to homosexuality is sexual abuse.” He goes on to discuss that sexual abuse can lead to isolation, distrust and psychological problems, and therefore leads to homosexuality.
4. Dr. Khoury adds that girls watching and interacting with other girls can lead to sexual attraction and homosexuality. He asserts that, in some cases, female homosexuality is due to failure of a woman to attract men. He claims that a woman would “become” a lesbian to compensate for her failure with men.

Unfortunately, almost all of what Dr. Khoury discussed is inaccurate and misleading. There is no scientific evidence linking spoiling children or sexual abuse with homosexuality. His attempt to explain female homosexuality is also not based on any evidence-based research or scientific knowledge.

We want to clarify that many theories have been proposed regarding the origins of homosexuality, but definitive answers have yet to be found. Research has not been able to discover the origins of homosexuality or of heterosexuality, for that matter. Similar to left-handedness and other human attributes, homosexuality is likely manifested due to a mixture of genetic, biological, and environmental factors.

We are surprised that Dr. Khoury speaks of a school which considers homosexuality a disease, when 40 years ago, in 1973, the American Psychiatric Association, a world leader on mental health, declassified homosexuality from its list of mental disorders. The following year, the American Psychological Association also declassified homosexuality as an illness. Since then, every major medical and mental health organization has followed suit. The World Health Organization (WHO) declassified homosexuality as a disorder in 1990. The WHO states that “in none of its individual manifestations does homosexuality constitute a disorder or an illness and therefore it requires no cure.” (2)

Currently, the global consensus among health care providers is that homosexuality is a normal and natural variation of human sexuality without any intrinsically harmful health effects. It is surprising and disappointing to see Dr. Khoury completely disregard this current common knowledge and instead, propagates out-dated stereotypes and misinformation that have clearly been proven to be false.

We are also very disappointed to see Dr. Khoury portray a very conflicted image of homosexuals who come out (i.e. those who do not hide the fact that he/she is gay/lesbian). Dr. Khoury uses the term “ positive rudeness” which is a very interesting and unusual term. He also states that these people are “out” because they have a “spirit of defiance.” We believe that gay and lesbian people are equal citizens in the societies where they live and therefore should have the right to express themselves without being called rude or defiant for simply being who they are.

Dr. Khoury refers to people who are not homosexual as being “3adi” (normal), which implies that he personally believes that being homosexual is abnormal.

Dr. Khoury also wrongfully explains that that Article 327 of the Lebanese Penal Code prohibits homosexuality. This is not true. Article 534 of the Lebanese Penal Code prohibits “unnatural sex between two people.” This law is often interpreted in Lebanon as referring to homosexual acts. In 2009, a verdict came out of a court in Batroun regarding Article 534, in which the judge discussed “nature,” negating the application of the article on homosexuals. (3)

When speaking of treatment, we agree with Dr. Khoury that sexual orientation cannot be changed. However, we are deeply concerned that he is admitting, on national television, that he encourages families to try to change their loved one’s sexual behavior.

Homosexual individuals in Lebanon suffer bullying, verbal and physical abuse, and discrimination from their families, schools, communities, and society at large. Around the world, fear of discrimination and prejudice has been found to alienate lesbian and gay individuals and lead to a delay in seeking health care. It remains our duty as health care providers to rid ourselves from any prejudice that might affect the health of our patients.

Dr. Khoury brings up a very troubling point at the end of his interview. He states that he sometimes recommends that people see homosexuality as a choice and treat it as such. Authorities in the field agree that sexual orientation is not a choice. In the same way that heterosexuality is not a choice, homosexuality is not a choice either. Suggesting that homosexuality is a choice puts homosexual people in Lebanon at higher risk for bullying, hate-crimes, and abuse since they may be perceived as willingly choosing what is morally unacceptable for the perpetuators of the discrimination.

Dr. Khoury ends his interview by asserting that we still do not have a good understanding of homosexuality and that we have no conclusive evidence about this subject. We would like to stress that this statement might have been true in 1969, but in 2013, we have overwhelming literature that indicates that homosexuality:

• Is not a choice
• Is not considered a disease
• Is considered a normal variation of human sexuality
• Cannot be changed and attempts to change from homosexual to heterosexual causes a great deal of harm to homosexual individuals.

LebMASH calls on all health care providers in Lebanon to be careful with the information they disseminate about homosexuality in the media. An up-to-date review of the scientific literature on the topic is necessary before any media appearance. LebMASH would be more than happy to provide any scientific evidence and literature needed on this topic. We owe it to the public to ensure the health information we are sharing is scientific, accurate, and unbiased.

References:

1. Wagner GJ, Aunon FM, Kaplan RL, Karam R, Khouri D, Tohme J, Mokhbat J. Sexual stigma, psychological well-being and social engagement among men who have sex with men in Beirut, Lebanon. Cult Health Sex. 2013 May;15(5):570-82. (Abstract)
2. The Pan American Health Organization/World Health Organization PAHO/WHO Position Statement. “Cures” for an illness that does not exist. 2012 May 17. (Retrieved on June 24 2013 from here)
3. “Lebanese Judge Rules Against the Use of Article 534 To Prosecute Homosexuals” Bekhsous. 2009 Dec 28. (Retrieved on June 24 2013 from here)

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Lebanese Medical Association for Sexual Health

 

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