Overcoming the stigma

Gay Lebanon leads in the region for tackling the HIV
Friday 15/01/2016

Beirut - The subject of AIDS in Lebanon is no longer a gloomy one. A recent study by the World Health Organisation (WHO) indi­cated the number of reported cases is receding. According to statistics published in early December, the number of cases of infected patients this year was 113.

The study also showed a contin­ued downturn in the number of Lebanese women infected by their husbands working in West Africa. Currently only 7% infected in 2015 have a “travel history”.

Yet while health workers and WHO officials are upbeat about the figures, many take a despond­ent view of one statistic that gives a dimension to the high number of males infected with HIV in Leba­non, a country synonymous with liberal, if not hedonistic Western values atypical of the Arab world.

More than one-third — 35% — of those infected with HIV/ AIDS contracted it through ho­mosexual intercourse, a sub­ject taboo in Lebanon although strangely more taboo with health workers and non-governmental organisations (NGOs) than society itself.

Lebanon has a visible gay scene that defies regular crackdowns from the state, which attempts a to­ken disdain for gay clubs and bars. And yet the gay scene survives.

But try using the word “gay” with WHO officials and NGO chiefs and the reporter faces a baptism of de­nial. The word “gay” has been air­brushed out of the subject due to the collective thoughts by all the partners active in the area as many health care professionals say stig­matisation against homosexual men will drive them underground.

Yet there’s much evidence to sup­port that and measures by the gov­ernment to introduce anonymous AIDS testing across 110 health cen­tres in Lebanon is proving a success. But it’s more than just getting gay men in for testing. It’s also about how they are treated once inside and diagnosed.

“Now, in Lebanon, we start treat­ment on HIV sufferers irrespective of their CD4 count,” Dr Mustapha Nakib of the WHO told The Arab Weekly in a telephone inter­view. “So everyone who is HIV positive diagnosed, we counsel him, and if he accepts, we start treatment immediately which might make, in time, the vi­rus undetectable in the blood.”

The CD4 count is a measure of immune function. By measur­ing CD4 levels doctors can see how HIV has affected the immune system, showing the progression of the virus. Care for people in­fected with HIV starts when a CD4 count exceeds a given threshold. In the United Kingdom, for, example, most people start treatment when their CD4 count is at 350.

Condoms are the real problem, though, in Lebanon, both from a cultural perspective and an eco­nomic one as it’s often overlooked that in poor countries few want to pay out for the protection. Yet, ac­cording to Nakib, who is the direc­tor of the HIV programme at the WHO in Beirut, many simply don’t know that with a little effort, con­doms can be obtained at no cost.

“For those in a vulnerable situ­ation, they might go to NGOs and find counselling and then be given free condoms… but so many oth­ers don’t go there so they need to buy them from pharmacies,” he added.

Ironically, despite Lebanon being modern and more toler­ant of a gay scene, there are health care workers who fear stigmatisation of gay men affects the number who come forward. In­deed, WHO statistics are cause for great dispute in Lebanon’s NGO com­munity.

Nonetheless, the WHO takes the more pragmatic view that men who have sex with each other can be assumed to be gay. And so the WHO concludes that gay sex is the chief reason for the lion’s share of AIDS/HIV cases in Lebanon.

Earlier in the year, an AIDS/HIV doctor practicing in Lebanon condemned the study for being gender specific — with a shocking lack of testing for women — and a health clinic also stated the studies were inaccurate sim­ply due to their limited scope in who it contacts as part of the survey.

A reputable Lebanese health cen­tre that specialises in sexually trans­mitted diseases (STDs) called Marsa agreed that gay sex (or “MSM sex” as they prefer to call it) is respon­sible for the increase in reported cases and claims that the price of condoms is a chief reason why AIDS continues to chalk up well more than 100 new cases each year in Lebanon.

Yet it also says that the figures are not accurate as a large part of sexual practices are not documented so the assertion of the high rate of gay sex cannot be substantiated, according to Marsa Manager Diana Abou Ab­bas.

More recently, her argument was supported by a Lebanese organisa­tion called SIDC, which is part of the Lebanese AIDS National Associa­tion.

A spokeswoman questioned the number of cases in Lebanon, which she estimated at being “well over 3,000″. She pointed to the 50% of those in the WHO study who do not state where or how they caught the virus.

“The numbers, which show that over 80% are transmitted through unprotected sex each year and half of these numbers are homosexual and bisexual. This is the new trend” she said in a telephone interview. “Every year we are witnessing more cases in the gay community.”