Lebanon is something of a test case for lesbian, gay, bisexual and transgender rights in the Arab world. It’s one of the most socially liberal countries in the region, but researchers who work on LGBT issues in the Levant country say it’s still tough to get people to open up about their sexuality and sexual orientation.

Lebanon became the first Arab country to celebrate gay pride in 2017, but the opening event had to be called off when Islamists threatened violence. Last year Beirut Pride week was canceled halfway through when one of the organizers was detained. Despite those issues, this year’s event is still scheduled for early October.

The resilience of the gay pride movement in Beirut is one reason to expect attitudinal and social change, but researchers say there’s still a long way to go. “It’s very challenging, even in Beirut, to get people to engage with me,” says Hady Naal, a research assistant at the American University of Beirut’s Global Health Institute.

‘Being LGBT Is Not a Disease’

Naal is also a former project manager at the Lebanese Medical Association for Sexual Health, an organization of healthcare professionals that seeks to achieve equality in medical care for all groups—emphasising the LGBT community’s needs.

In a recently published study, carried out with the association, Naal looked at the attitudes of healthcare providers toward LGBT patients.

His results showed a statistically significant difference between the mind-sets of mental healthcare specialists and general healthcare providers.

For example, mental healthcare professionals were less likely to believe that homosexuality is a mental health disorder or that identifying with a gender other than one’s sex at birth is unnatural. They were also more likely to address transgender people by their preferred pronouns.

Naal’s findings offer lessons for others, says Omar Fattal, associate director of inpatient psychiatry at Bellevue Hospital in New York and member of the editorial board of the journal LGBT Health. Originally from Lebanon, Fattal is also a founder of the Lebanese Medical Association for Sexual Health.

“The Lebanese Psychiatric Society is an official body and it came out and said that being LGBT is not a disease,” says Fattal. “It went on further and said it is normal and you shouldn’t do conversion therapy. That was huge.”

That announcement, first published in 2013, has since filtered down through the ranks of mental health providers and increased their positive attitudes toward the LGBT community, says Naal.

“We know, based on the differences in responses between mental health providers and non-mental health providers, that at least something works,” says Naal. “When you train people and say it’s not a disorder to be LGBT, it’s reflected in positive attitudes.”

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Sampling Size in Arab Sexuality Research

Naal contacted a total of 4,500 healthcare professionals to invite them to be part of that study, but less than 3.4 percent agreed to take part.

“That’s a strikingly low response rate,” he says. “Sampling is a huge problem because those who are more accepting of the topic are far more likely to respond. Sampling bias is a big issue for us to consider and also data collection in general is an issue—you find that people just don’t want to talk about it.”

Others agree. Ismaël Maatouk runs a private clinic in Beirut that specializes in sexual health and his research has also focused on the psychosocial aspects of men who have sex with men in Lebanon.

“I’ve never had pushback on my work from disapproving colleagues or the general public,” he explains. “But it is hard to recruit people for studies and the health ministry is never going to conduct a large-scale study on LGBT people because the community isn’t something that’s recognized.”

These sampling issues mean it can be hard for academics like Naal and Maatouk to get their work published.

“When you submit papers, journal editors will often criticize it and say it’s too small or not representative enough, but that’s usually because they don’t understand the context,” says Maatouk.

The concerns about data accuracy are genuine and it does present a real problem, he says, but so little research is coming out of the region on this topic that researchers say any studies should be welcomed as a starting place, so long as the authors acknowledge a study’s limitations in the write-up of their results.

Naal says some editors are better than others at understanding the challenges of doing research on LGBT issues in the Arab world.

“A journal that deals specifically with LGBT issues will be more understanding,” says Naal. “With international journals, there’s some curiosity about LGBT research in the Arab world so any LGBT study would warrant consideration to be published because of the scarcity of such research.”

The Importance of LGBT Research

People need to care about LGBT-related research in the Arab region, argues Maatouk, because it has the chance to improve or even save people’s lives.

“It’s important to study LGBT people because we know HIV is concentrated in key populations, one of them being the LGBT community. If you want to deal with HIV then you have to engage with them,” says Maatouk. (See a related article, “AIDS Deaths Soar in the Arab Region”).

Naal agrees.

“LGBT related issues are important to study because there are many challenges you face if you’re LGBT in Lebanon, like stigma and discrimination,” says Naal. “It’s important to know how to tackle this to improve their health and reduce the prejudice and bias they face.”

The results available in the Arab region come almost exclusively from studies in Lebanon—even more specifically, from within certain areas of Beirut. That makes it hard to know what the situation is like in other countries or whether what researchers know from these studies can be applied elsewhere.

“Why aren’t we talking about the wider Arab world?” asks Fattal. “The answer is that the Arab world is huge and so different. You can’t put Saudi Arabia or Egypt or Lebanon in the same sentence for this topic. It’s extremely complicated and every country deserves its own examination.”

But every country isn’t getting its own examination right now. “I would assume that there’s a bit more acceptance in Tunisia and Morocco compared to places like Saudi Arabia and the U.A.E.,” says Naal. “But to be honest it’s very hard to say that with confidence because I haven’t seen much, if any, research from those countries.”

Optimistic Outlook

Despite the sparsity of data and investigation into LGBT issues in the region, the researchers say they’re somewhat optimistic about the future of such research. They say the trajectory of social change is pushing Lebanon, at least, toward more tolerance.

“It’s hard to measure these things but when I was growing up in Lebanon 30 years ago it was very common to use the word ‘deviant’ in the media. You didn’t’ use the word ‘gay,’” says Fattal. “Now the media uses more neutral terms.”

“In Lebanon there is a shift in public support towards being more supportive, but if you woke up tomorrow with a different government it could all change again,” says Fattal.