On the 26th July 2014, the M-Coalition, hosted by the Arab Foundation for Freedom and Equality, was launched at the International AIDS Conference in Melbourne, Australia. The M-Coalition, featuring delegates from 5 Arab countries- Lebanon, Morocco, Algeria, Mauritania and Tunisia – seeks to better facilitate the access that men who have sex with me (MSM) have to HIV/AIDS prevention, care and treatment. Furthermore, another aspiration of the grouping is to encourage healthcare professionals to treat MSM clients in the same way as all their clientele. The M-Coalition is, furthermore, the only Arab HIV/AIDS organisation specifically dedicated to the needs of MSM, who are between 50 and 130% more likely to have HIV than the general population across the Arab World – according to M-Coalition’s own statistics.
The MENA (Middle East and North Africa) region, as compared to Sub-Saharan Africa, is generally considered to have low levels of HIV and AIDS across the populace, with the exceptions of Djibouti, Somalia and South Sudan. However, within the target group, who are also one of the most vulnerable social groups, subject to arrest and legalised torture, the rates are disproportionately high, explaining the need for such a group to come together to help create a better environment for MSM to seek treatment.
Johnny Tohmy, Executive Director of M-Coalition, said “at this key moment where the end of the HIV epidemic is potentially within reach, we have committed to increase our efforts envisioning an Arab world where right to health and all other human rights of MSM are recognized, realized and protected.” (Full article found here)
LebMASH is proud to work with the M-Coalition and would like to congratulate Dr. Omar Harfouche, one of the founders of LebMASH, on his concurrent position on the M-Coalition board. Dr. Harfouche was selected by the members of the M-Coalition to work with them. We believe that the participation of the M-Coalition at the International AIDS Conference is a great step forward, representing the unheard voice of the MENA region within the discussion of LGBT rights and HIV/AIDS rights, both subjects traditionally considered taboo within the Arab World.
Dr. Harfouche explains that “the importance of the M-coalition lies with the exchange of all the experience and expertise of different organizations and different approaches from different countries in the Arab world. While meeting in Tunisia with the rest of the board members, we are able to look at the ways of addressing discrimination against PL-HIV (people living with HIV) and MSM in different countries and try to think of different ways to tackle these issues based on each person’s own experience.
“M-coalition’s strength also lies in being a new reference point for MSM living with HIV in the region and on prevention strategies for this key population. This population has been neglected by many prevention campaigns and this subject wasn’t tackled the way it should have been, knowing that MSM are still one of the most populations at risk in the MENA region.
“Finally, here’s what I think LebMASH can offer to the M-coalition: I will be representing Lebanon in the M-coalition and not only LebMASH but I feel that the medical background that LebMASH has is of great importance to guide other initiatives that would work with health care professionals in the MENA region.”
On the ninth of August, Lebanese police, from the Hbeish police station, which has formerly been criticised for using the anal probe test to investigate human sexuality, arrested 27 men in a Beiruti bathhouse, Agha Hammam, in the Hamra-Concord district of Beirut. The police have reported that all men were unarmed and that the police had arrested the men based on tip-off information from a previously arrested gentleman, who claimed that Agha Hammam was a meeting place for men seeking to have sex with other men. The raid, according to Helem, the Arab World’s first LGBT rights organisation, is the largest since the Borj Hammoud cinema raid in 2013.
Whilst the anal test has been used by this particular police station before, despite the fact it runs against the Lebanese Order of Physicians’ (LOP) Code of Conduct, the police have announced that, thankfully, it was not inflicted upon these unfortunate men. However, Colonel Tony Haddad of the police has claimed that the sexual orientation of 24 of the men has been ‘confirmed’, whereas 3 of the men have been described ‘not gay’.
Despite the branding of the majority of these man as ‘Luwat’ by such media outlets as MTV Lebanon (translating to ‘fags’, in English), there is no proof that any sexual intercourse or activity was taking place at the time of the arrest. The owner, employees and all the clientele present at the time were arrested. The clientele remain in custody.
A coalition of 5 advocacy groups – Helem, The Arab Foundation for Freedom and Equality (AFE), The Lebanese Medical Association for Sexual Health (LebMASH), M-Coalition and Marsa Sexual Health Clinic – have come together and released a strong position statement, saying: “we denounce this incident as a case of homophobic practice that aims to police the sexual rights and liberties of the individuals involved… We call on the General Prosecutor and Hbeish police station to respect the dignity of the detainees and their rights to their (sexual) bodies.”
Legal Agenda, a human rights organisation in Beirut, have announced that the men have been held longer than is legally allowed by the Lebanese Penal Code, for, under Article 47, they may only be held for 48 hours, which is renewable once. However, under Article 105, crimes which are punishable by only one year in jail do not apply. The men are understood, however, not to be being charged with the standard Article 531, which condemns homosexual intercourse as ‘unnatural’, but, rather to be being charged with Article 521, which condemns public indecency.
Sarah Wansa, of Legal Agenda, told Al-Akhbar (a Lebanese daily newspaper), that they [Legal Agenda] no longer consider homosexuality to be a crime punishable under Article 534 because of its designation of homosexuality as ‘unnatural’ – a claim which LebMASH has been stridently fighting against through its seminars around Lebanon.
There have been two precedents where homosexuality has not been punished by Lebanese judges. However, because Lebanese law was based on the French Civil Law system, rather than the English Common Law system, these precedents do not change future rulings, meaning that homosexuals will still be at risk of prosecution under Article 534 is no longer applied to homosexuality.
Anal tests for homosexuality are not useful in assessing someone’s sexual orientation or behavior and can be harmful physically and psychologically
The Lebanese Medical Association for Sexual Health (LebMASH) has recently learned that a Forensic physician in Lebanon, Dr. A. M. has conducted anal tests on several individuals to determine their sexual orientation.
LebMASH is extremely concerned to hear that this practice, “the anal test”, continues to take place in Lebanon especially given that:
– This test is antiquated and does not yield any useful information about a person’s sexual orientation or behavior.
– This test can be harmful physically and psychologically to the person receiving it.
– The order of physicians in Lebanon banned this test in an official Memo in 2012.
– The test is unethical, violating a major component of the Hippocratic Oath: non-maleficence or “first, do no harm”.
Before we discuss the anal test itself, it’s important to understand that male homosexuality has three different aspects to it:
- Sexual orientation: the sexual and/or emotional attraction to another person of the same sex and the desire to be with this other person.
- Sexual behavior: the actual sexual acts that involve two men and can include kissing, body contact, oral sex, mutual masturbation, anal stimulation, and anal intercourse.
- Sexual identity: identifying socially as being homosexual or gay.
A person can have a homosexual sexual orientation but not engage in sexual behavior with other men and without identifying as gay. Another person can have a homosexual sexual orientation and engage in sexual behavior with other men but not identify socially as gay. And finally, a person can have homosexual sexual orientation, engage in sexual behavior with other men, and identify socially as being gay.
The so-called anal test for homosexuality involves the insertion of a metal object into a man’s anal canal through the anus allegedly to find out if this person is homosexual. Homosexuality, just like heterosexuality, is a very complex construct and can’t possibly be determined by a simple test.
The only “medical” reference to the use of the anal test in relation to homosexuality is a paper published by a French medico-legal expert named Auguste Ambroise Tardieu back in 1857. Tardieu claimed that “chronic sodomites” have certain specific penile and anal physical characteristics that are unique to them.
Today, over 150 years later, we know that what is mentioned in Tardieu’s study is not true. Adult men who engage in consensual anal intercourse do not have any permanent penile or anal characteristics that are unique to them. Therefore performing an anal test on them is futile.
The anus is the external opening of the anal canal, which is the terminal part of the human colon. The anus has 2 sphincters: the internal anal sphincter that is an involuntary muscle and the external anal sphincter that is a voluntary muscle (i.e. can be opened and closed at will by the person).
If we examine the report of Dr. A. M. more closely, we can see in more details how misguided he is about both normal anal anatomy and homosexuality. In his report, Dr. A. M. mentions that there was “no evidence of accumulation, tear or redness”. Normal homosexual anal intercourse between two consenting adults does not lead to “accumulations, tears or redness”. Even if there was evidence of any of these findings on an anal exam, these findings can be attributed to a number of medical conditions such as an anal abscess, an anal fissure, constipation or hemorrhoids all of which can cause changes in the anal mucosa.
Dr. A. M. also mentions in his report that “the anal sphincter is functioning normally”. Adult men who engage in consensual anal intercourse, even if it is on a regular basis, do not have abnormalities in the functioning of their anal sphincters. The anal sphincters have the natural ability to expand when needed (for example to receive anal intercourse) and return to their normal size and tone afterwards. This is seen every day when passing a bowel movement. The internal anal sphincter relaxes naturally and the external sphincter is voluntarily relaxed to allow for defecation. However, following this, both sphincters return to their normal tone and functioning.
Performing an anal test on someone to find out information about someone’s sexual orientation or behavior is not only futile, but can also be very harmful physically and psychologically.
Physically, inserting a metal object into an anal canal in an uncontrolled location such as a police station can place the person at risk for infections such as Human Papilloma Virus (HPV) and Hepatitis, to mention a few. Inserting an object as small as a finger into one’s anal canal by a Forensic doctor can cause excruciating pain and/or tears, even for someone who regularly engages in anal intercourse. The difference is that when engaging in normal anal intercourse, the individual has the chance to gradually and voluntarily relax the anal sphincters, as well as many muscles that exist in the perineal area, in order to receive anal intercourse, that is perceived as pleasurable by this individual. On the other hand, and similar to being raped, inserting an object as small as a finger into someone’s anal canal without their consent and without giving them the chance to gradually relax their muscles will lead to the opposite scenario, i.e. to further contracture of the anal sphincters and perineal muscles, and therefore will lead to severe pain and possible injury.
Psychologically, subjecting someone to this anal test discussed here can lead to severe psychological trauma similar to the trauma that individuals can endure after being raped. In addition to the shame and humiliation, the individual subjected to this cruel procedure is at risk of developing Post Traumatic Stress Disorder (PTSD) and possibly sexual dysfunction by being unable to receive normal consensual anal intercourse or even anal stimulation in the future.
LebMASH calls on the Lebanese Order of Physicians (LOP) to take responsibility for the actions of one of its members by enforcing disciplinary measures on Dr. A.M. to reinforce LOP’s ban on these tests issued on Aug. 7, 2012.
LebMASH reiterates its position regarding homosexuality being a normal variation of human sexuality and therefore not a medical or psychiatric condition that requires diagnosis or treatment.
LebMASH is happy to provide LOP members and especially to Dr. A.M. cultural competency training and consulting for issues related to sexual orientation and gender identity.
LebMASH urges the LOP to issue an official statement, similar to those issued in July of 2013 by the Lebanese Psychiatric Society and Lebanese Psychological Association, asserting that homosexuality is not a disease and that homosexuality is a normal variant of human sexuality.
We also call on the law enforcement agencies in Lebanon to abide by Lebanon’s commitment to the Universal Declaration of Human Rights, especially Article 5 the part relating to humane treatment of people in custody. We call on those agencies to respect people’s right to the integrity of their bodies. LebMASH calls on lawyers and judges to stop using Article 534 of the Lebanese penal code to criminalize homosexuals since the sexual act between two consenting adults of the same gender is not “against nature.”
Beirut, May 17 2013- Homosexuals continue to face prejudice and discrimination within our Lebanese society. This prejudice and discrimination extend beyond the general public to some healthcare providers who continue to offer “Conversion or Reparative Therapy” with alleged goal of changing one’s sexual orientation.
The Lebanese Medical Association for Sexual Health (LebMASH) finds it necessary to clarify the following facts:
1. Homosexuality is not a disease – 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 declassified homosexuality as an illness. Since then, every major medical and mental health organization has come to embrace this view. The World Health Organization (WHO) declassified homosexuality in 1990.1 WHO states: “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 healthcare providers is that homosexuality is a normal and natural variation of human sexuality without any intrinsically harmful health effects.
2. Origins of homosexuality are not known – Many theories have been proposed regarding the origins of homosexuality but definitive answers are 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 and environmental factors.
3. Homosexuality is not a choice – In the same way that heterosexuality is not a choice, homosexuality is not a choice either.3
4. Homosexuals are at higher risk for psychological problems – Homosexuality itself does not lead to mental illness. Stigma, peer rejection, discrimination, heteronormative bias, bullying, internalized prejudice, and the stress of disclosure about one’s sexual orientation to others (known as “coming out”) place homosexuals at a higher risk for psychological problems. This may include mood and anxiety disorders, substance abuse, and suicidal ideations and attempts. Such stressors cause more alienation and have grave effects on one’s health and wellbeing.4
5. Attempts to change one’s sexual orientation can be harmful – Efforts to change sexual orientation are not based on any sound scientific evidence. On the contrary, this practice has been abandoned due to proven failure and serious harmful effects. Dr Spitzer, the father of reparative therapy recanted his position on reparative therapy in 2012.5
Many health organizations have condemned these “therapies.” The American Academy of Child and Adolescent Psychiatry warns about the lack of evidence that sexual orientation can be altered through therapy, and that attempts to do so may be harmful.4
The American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation concluded that efforts to change sexual orientation are unlikely to be successful and involve some risk of harm, contrary to the claims of SOCE practitioners and advocates.6
The American Psychiatric Association recommends that ethical practitioners refrain from attempts to change individuals’ sexual orientation, keeping in mind the medical dictum to first, do no harm.7
Similarly, the American Academy of Pediatrics warns that any attempt to change sexual orientation is contraindicated since it can provoke guilt and anxiety while lacking potential for achieving changes in orientation.8
The American Medical Association opposes the use of ‘reparative’ or ‘conversion’ therapy.9
On May 17th 2012, 22 years after homosexuality was removed from the WHO International Classification of Diseases (ICD-10), the PAHO (Pan American Health Organization, a regional office of WHO) released a position statement stating that “‘Reparative’ or ‘conversion therapies’ have no medical indication and represent a severe threat to the health and human rights of the affected persons. They constitute unjustifiable practices that should be denounced and subject to adequate sanctions and penalties.”2
Based on the above, the Lebanese Medical Association for Sexual Health (LebMASH) urges healthcare providers in Lebanon to refrain from this unethical and potentially harmful practice. We also urge health care organizations to take a strong position against such practices.
LebMASH – The Lebanese Medical Association for Sexual Health
Lebanese Medical Association for Sexual Health. Position Statement on Sexual Orientation Change Efforts (SOCE). May 17 2013 (Retrievable at https://lebmash.wordpress.com/2013/05/17/ps1-en)
1. World Health Organization (1994). International Statistical Classification of Diseases and Related Health Problems (10th Revision). Geneva, Switzerland. (Retrieved on May 6 2013 from here)
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 May 6 2013 from here)
3. American Psychological Association. (2008). Answers to your questions: For a better understanding of sexual orientation and homosexuality. Washington, DC: Author. (Retrieved on May 6 2013 from here)
4. Adelson SL; American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI). Practice parameter on gay, lesbian, or bisexual sexual orientation, gender nonconformity, and gender discordance in children and adolescents. J Am Acad Child Adolesc Psychiatry. 2012 Sep;51(9):957-74.
5. Benedict Carey. Psychiatry Giant Sorry for Backing Gay ‘Cure’. The New York Times – May 18, 2012 (Retrieved on May 6 2013 from here)
6. Report of the American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation. (Retrieved on May 6 2013 from here)
7. APA Commission on Psychotherapy by Psychiatrists. Position statement on therapies focused on attempts to change sexual orientation (reparative or conversion therapies). Am J Psychiatry. 2000 Oct;157(10):1719-21.
8. Committee on Adolescence – American Academy of Pediatrics. Homosexuality and Adolescence. Pediatrics 1993 Oct;92 (4):631-34. (Retrieved on May 6 2013 from here)
9. H-160.991, Health Care Needs of the Homosexual Population. The American Medical Association Policies on GLBT Issues. (Retrieved on May 6 2013 from here)