LGBTQ research in Lebanon has never been more difficult nor more important. Dr Ismäel Maatouk feels compelled to continue because of the coming sexual health crisis.
Lebanon is a country in trouble. It has faced a near unfathomable sequence of calamities in recent years, bringing one of the Arab world’s most socially liberal countries to the brink of collapse. Alongside the pandemic, the country is enduring a prolonged financial meltdown. According to nonpartisan research network Arab Barometer, 61% of Lebanese people say the economy is their country’s biggest concern whereas just 7% list COVID-19, showing just how cash-strapped the country is. Fuel shortages and power outages are also a frequent occurrence.
Then in the summer of 2020, chemicals that had been incorrectly stored in Beirut’s port for years exploded. It was the world’s largest non-nuclear blast and it killed more than 200 people, destroying vast parts of the capital city. Such was the force of the explosion that many buildings are yet to be repaired.
One of the worst hit neighbourhoods was Gemmayzeh, an LGBTQ-friendly part of town. “It was a hub for the LGBTQ community. It was full of boutiques and nightlife,” says Dr Ismäel Maatouk, who runs a clinic in Beirut specialising in sexual health and researches the sexual and mental health of men who have sex with men in Lebanon. “Many people in the community were physically scarred and left jobless from the destruction,” he told The Brilliant. “Many are traumatised and leaving the country.”
Further roadblocks
This makes Maatouk’s research even more difficult than it already was. Studying LGBTQ communities is not easy in the Middle East, where it’s often illegal to be anything other than straight and cis. When you add in the immense social stigma, it makes such research essentially impossible in many Arab countries.
That’s cause for concern, says Maatouk, because the absence of research on LGBTQ people has a tangible and negative impact on the community. It’s well known that LGBTQ people are more likely to suffer from mental health problems, for example, and men who have sex with men are also more at risk from a sexual health perspective. However, we can’t assume that findings and recommendations from Western studies will automatically translate into the Arab context, he says, so until we have large-scale reliable data on these issues from within the Arab world, these problems are unlikely to improve.
Homosexuality is still technically still illegal in Lebanon. But the law, which criminalises “all sexual relations contrary to the laws of nature” stretches back to French colonial times and is rarely used. This makes it at least possible to study LGBTQ communities in Lebanon. “Even here it’s still very challenging to study this population,” says Maatouk.
The largest barrier to his work is finding enough people to recruit for his studies, rather than any political or legal quandaries. This can make it hard to publish papers because academic journals often refuse to move forward with small sample studies as part of their quality-control processes.
A sexual health crisis in the making
Yet Maatouk carries on, determined to study the problems faced by LGBTQ people in Lebanon with the hope that emphasising the issues with data is the first step towards improving LGBTQ lives. His most recent data, published in the BMJ, was collected during the initial COVID-19 lockdown in the spring of 2020. It highlights a worrying trend in the sexual health of men who have sex with men.
His clinic noticed a sizeable 73% fall in testing rates for sexually transmitted infections (STIs) in 2020 as compared to 2019. Simultaneously, there was a 34% increase in post-exposure prophylaxis (PEP) prescriptions, a drug therapy for people who have been put at risk of HIV infection, commonly due to having sex without a condom. “This means despite the lockdown there was an increase in risk-taking behaviour,” says Maatouk. “This is contrary to the findings of similar research conducted in other countries, and it suggests that Lebanon may have a looming sexual health problem to deal with.”
Maatouk’s previous research has estimated that the prevalence of HIV among Lebanese men who have sex with men is relatively high at 12%. The prevalence of having at least one symptom of an STI was even higher at 35%. These figures may have risen even further if the increase in unprotected sex and decrease in sexual health testing that Maatouk observed during Lebanon’s 2020 lockdowns holds true nationwide.
Additionally, treatment for STIs in Lebanon has become increasingly tough to access with all of the country’s economic and supply chain woes, which were worsened by the port’s destruction. “July 2021 was even worse than the blast itself for me, if I’m being honest,” says Maatouk. “The power kept being cut and so I was only able to take emergencies because the generator could only do two hours a day.” Antibiotics also became difficult to source and so Maatouk was worried about not being able to treat common STIs such as gonorrhoea.
“This is weirdly where things got better, or at least more positive,” says Maatouk. “I was begging people to let me know if they knew of anyone travelling from other countries and if so, I’d beg them to bring medications with them.” If those people were coming from a country where you don’t need a prescription for antibiotics, such as Turkey, he’d ask them to bring the right drugs so he could help his patients fight gonorrhoea.
And people did, in such quantities that it overwhelmed Maatouk. “They understood it was for the LGBTQ communities and you have no idea how many antibiotics I got for free,” he says. “They wouldn’t let me pay – it was a donation. It’s positive things like this that are getting me through. There is solidarity and it’s wonderful.”
Article by Benj Plackett