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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 28th of February 2014 LebMASH organised a session on sexual health with a support group of female victims of domestic violence at KAFA.
The session was held by Dr. Sally Khoury, a gynecology senior resident at AUB-MC, and it consisted of a Q&A on different topics on sexual health. The interest of the women from the support group in this topic and their need to know more about their own sexual health proves that something is lacking in awareness on women’s sexual health.
Even though many initiatives to educate women more on sexual health were taken, women still lack basic information on their own sexual health. They also fear visiting the gynecologist and discussing anything related to sexual health. This is undeniably due to the taboo and the social stigma that is associated with sexual health and with women’s sexual health in particular. In Lebanon and in other Arab countries, the discussion of women’s sexual activity, pleasure or even sexual health is not considered morally appropriate.
One of LebMASH’s main activities is to spread awareness among groups that face discrimination, for instance sexually active women and victims of rape. Furthermore, we know that an important step is to make gynecologists, physicians or even health care professionals in general more aware on how to help their patients feel more comfortable whilst talking about their sexuality and when addressing their sexual health.
Finally, we would like to thank Dr. Khoury for her efforts and KAFA for the opportunity to collaborate and we enthusiastically hope to work together on many more projects in the future.
LebMASH’s Vice President – Omar Harfouch
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.