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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.”
The Lebanese Medical Association for Sexual Health (LebMASH) is proud to announce the winner of the 2014 “Break the Silence” competition as Rami Shukr.
To enter the competition, students in the medical field were asked to submit an essay about a specific issue related to either women’s sexual health or LGBT (lesbian, gay, bisexual, transgender) health in Lebanon.
Submissions are reviewed and graded by LebMASH’s Executive Board. The winner receives funding to attend a medical conference anywhere in the World. This year’s choice was the Gay and Lesbian Medical Association (GLMA) 32nd annual conference to be held in Baltimore, Maryland from the 10th to the 13th September 2014. This year’s conference theme is ‘Innovation & Collaboration for LGBT Health Equality’.
Rami, who will graduate this year from the Lebanese American University with a BA in Pscyhology, entered the competition in order to “contribute to the growing movement of LGBT research in Lebanon”. He wants to shift the discourse on LGBT health and other issues away from the traditional and moral dogma towards a scientific and research based focus.
His prize-winning paper focused on stress, identity, and community among a sample of gay men in Beirut. Although there are Lebanese studies on MSM (men who have sex with men), there is no study, which uses culturally-relevant research, on the dynamics of MSM/gay (self-)identification. He also sought to investigate the feelings gay men have about the current state of advocacy in Lebanon and what they believe is lacking or could be improved. In his own words, he believes that “Investigating these factors would help elicit better advocacy and would help us point-out where change is most needed. Although my research was quite preliminary in nature, focusing exclusively on gay men, it could provide a starting point for more empirical research into the dynamics of LGBT stress, identity, and community in Lebanon.”
LebMASH formally congratulates Rami on winning the competition. We would also like to thank all the entrants whose essays we received. Finally, we take this opportunity to encourage as many students as possible to apply for next year’s competition.
On the 29th May 2014, LebMASH was hosted by Université Saint-Joseph in Beirut to give a talk on the perceptions of homosexuality within the medical profession and wider society. Chaired by Dr. Sami Richa, head of psychiatry at the university, and Father Michel Scheuer, head of the university’s ethics department, the talk was the first time that the subject of sexuality and gender identity had been broached within the Jesuit-run university. In his introductory address, Dr. Richa explained that the goal was to understand the problems of the LGBT (Lesbian, Gay, Bisexual and Transgender) community, being a medical subject of great importance. The talk was attended by over 100 people, including many medical students from the university and members of the public.
There were three speakers, two of whom came from LebMASH. Dr. Fattal, a board member, discussed the approaches that the students might take towards their LGBT patients, focusing on the state of medical care in Lebanon for the LGBT community today and how it might change in the future. He particularly emphasised a gender and orientation inclusive way of speaking, so that it appears to the patient that the doctor has thought through every possibility. He also addressed the lack of understanding around the gay community, hoping to shed some light on the myths and realities of the LGBT community.
Dr. Hala Kerbage, also of LebMASH and a psychiatrist at Hôtel-Dieu de France, followed his talk, by discussing the historical perceptions of homosexuality around the world. She focused her attention on studies such as the Hooker Report of 1957 which was the first report to research non-patients, meaning that for the first time, people without current medical or mental illnesses were part of a research experiment. Hooker found no more signs of psychological disturbances in a group of non-patient homosexuals compared to non-patient heterosexual controls. Dr. Kerbage also referenced the Kinsey Report, which found that 37% of people have experienced at least one homosexual act in their life. The Beach and Ford study was also mentioned and this study found homosexuality to be common across cultures and to exist in almost all nonhuman species. Their work supported the idea that homosexuality was natural and more widespread than previously thought.
She then turned her attention towards Lebanon and Article 534, which unfairly criminalises homosexuals forbeing ‘unnatural’. However, consistently throughout the talk, she had proved that homosexuality was not a mental disorder or a deviance from the norm, indeed it being normal. Recently, LebMASH, the Lebanese Psychiatric Society and Lebanese Psychological Association, have all come out against the classification of homosexuality as unnatural and stood against conversion therapy, stating that it is not effective and it is harmful for the individual.
The final talk of the conference was presented by Ms. Mima Mzawak, a sociologist, who spoke about homosexuality beyond the social perception. Science is the best method, according to Ms. Mzawak, to discover the truth about Man, halting the continued use of institutionalised terms for the LGBT community and stereotypes surrounding what it means to be a man, or a woman. She focused on different approaches towards combatting homophobia.
LebMASH would like to thank Dr. Richa and Father Scheuer and the Université Saint-Joseph for hosting the talk. We would also like to thank the over 100 attendees for their attentiveness and considered questioning.
On the 31st May, 2014, the Lebanese Medical Association for Sexual Health (LebMASH) held a 5-session medical conference on
health needs of LGBT (Lesbian, Gay, Bisexual and Transgender) individuals in Lebanon, in the West Hall of the American University of Beirut (AUB). The day commenced with an introduction by Dr. Faysal El-Kak, a senior lecturer at the Faculty of Health Sciences at AUB. Drs. Hasan Abdessamad, founder and current president of LebMASH, and Omar Fattal, co-founder and executive board member of LebMASH, presented on the topic. Dr. Nesrine Rizk, AUB instructor of infectious diseases, gave an elaborate talk on sexually transmitted diseases (STDs). The session lasted throughout most of the day and was followed by a Q&A session with strong interaction from the audience.
Dr. El Kak spoke about the need for such seminars, discussing how “no healthcare is complete without healthcare for all people, based in human rights” and that these seminars go a long way to helping people understand homosexuality and not view it simply in the light of the myths surrounding it.
Then, Dr. Fattal presented the same talk that he had given at Université Saint Joseph the previous week, which discussed the history of, and perceptions towards homosexuality. Focusing on the difference between attraction, behaviour and identity, he underlined that healthcare providers must not jump to making assumptions, without focusing on each area of the patient’s sexuality. However, he stressed that questions about sexuality and sexual health are of the utmost importance.
Dr. Abdessamad discussed the health of lesbian patients (and you can watch his talk with Arabic subtitles on LebMASH’s YouTube channel). Briefly, he underlined specific challenges faced by Lesbian patients, such as access to care. He stressed that in an ideal world there would be no need to discuss lesbian health as a separate topic since physicians should provide care to all patients equally, regardless of their sexual orientation. However, we do not live in an ideal world. He elaborated on how Lesbian and bisexual women’s health differs from that of heterosexual women, such as an increase in heart disease, breast cancer, substance abuse or obesity among others. This difference is not based in intrinsic or biological factors but rather extrinsic ones due to social and institutional discrimination.
Dr. Nesrine Rizk took the attendees through the A to Z of STDs, showing pictures of what to look for and explaining the symptoms and likelihood of sexually transmitted diseases amongst various different social groups.
Finally, Dr. Fattal returned to the stage where he discussed barriers to care faced by LGBT patients and suggested various ways by which healthcare providers can improve LGBT patients’ experience when they seek medical care. For instance, he spoke at length on the need for an inclusive language and a welcoming and relaxed body language.
Dr. Nesrine Rizk discussing the various STIs which doctors must watch out for, focusing on the specific threats facing the LGBT community.
LebMASH would like to thank the Continuing Medical Education (CME) Office at AUB who helped organise the event and hosted us within the university.
Below is a link to a part of Dr. Hasan Abdessamad’s talk on Lesbian health.
- En Français ici
Saint Joseph University’s Ethics Department & The Department of Psychiatry at the Faculty of Medicine are pleased to invite you to a conference on “Homosexuality seen by professionals” at Amphitheater C at USJ’s Faculty of Medicine on May 29th 2014, 5-6:30 pm.
Moderators: Father Michel SCHEUER and Dr Sami RICHA
- Interviewing techniques when working with LGBT people – Dr Omar FATTAL (Psychiatrist – USA, Lebanese Medical Association for Sexual Health – LebMASH)
- Evolution of the perception of homosexuality by the medical profession – Dr. Hala KERBAGE (Psychiatrist – Hôtel-Dieu de France)
- Homosexuality beyond the social perception – Miss Mirna MZAWAK (Sociologist – Holy Spirit University of Kaslik – USEK)
LebMASH would like to thank Mr. Antoine Bedaoui for designing this event’s poster.
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.