Discrimination Against LGBT: A Medical Legacy?

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For almost two years, my obsession has been to improve lesbian, bisexual, transgender, and queer women’s access to health services in Lebanon. Throughout these two years, I argued that this particular group of women ought to be addressed differently by health practitioners who – once aware of these women’s sexual orientation and/or gender identity – would be able to provide more accurate and relevant diagnoses.

Last year, and with the help of Meem’s members, we combined and set up a list of doctors (not only gynecologists but of all medical specialties) who were identified as LBTQ-friendly. The project that came next was a prevention guide on sexually transmitted diseases and infections (STD/STI) for women who have sex with women. Both projects were criticized for potentially adding to the marginalization of LBTQ women – especially those living with STIs – among health practitioners and within the community.

Nevertheless, raising awareness in our community remains crucial, and not only because of the social stigma that surrounds our sexuality. After all, the very notion of a woman’s sexuality, whether heterosexual or homosexual, is still rather taboo in our mainstream society. In fact, many straight women who have heard of our LBTQ-friendly list through word-of-mouth have asked for contacts of doctors who wouldn’t discriminate against sexually active single women. Raising awareness among LBTQ women in particular is essential because recent research has shown that LBTQ women are less likely to seek sexual health services, and that “lesbians were most likely to have never had a Pap test or be under screened.”[1] For instance, while HPV can be sexually transmitted between women, and “despite sharing most of the same risk factors as heterosexual women, lesbians are much less likely to undergo regular [cervical] screening.”[2]

When trying to comprehend the underlying reasons behind this lack of interest in seeking health services, results revealed that “butch women had routine gynecological examinations significantly less frequently, perceived poorer treatment in healthcare settings, were more likely to be out within healthcare settings, placed more importance on securing LGBT-positive healthcare practitioners, and had more difficulty finding LGBT-positive medical doctors. No differences were found for mental health. The results suggest that butch women may be more at risk for physical health concerns than femme women, in particular those illnesses that can be prevented or treated with regular gynecological care.”[3]

The safety of the environment where a patient is revealing her sexual orientation cannot but correlate with whether or not she will be encouraged to seek sexual health services in the first place or not. “Implications of the study include greater awareness among healthcare professionals of sexual minority gender identity in addition to sexual identity, and more support for butch-identified women to access vital healthcare services.”[3] It is therefore not only the community who ought to be addressed about the hazards of health casualness but rather, what is crucial, in our Lebanese society, is a discourse approaching physicians and health practitioners and their role in providing such a safe space for LBTQ women.

Unfortunately, amidst a medical discourse aiming towards justice and equality in treatment, some physicians, if not the majority, in Lebanon still consider homosexuality to be a mental illness.

Richa is just one of many lecturers who educate medical students that homosexuality is against nature and who trains future physicians into adopting homophobia and heteronomativity into their clinical approach.

In fact, in a psychiatry course given to Med 2 students at the Université St. Joseph, one of the country’s leading medical schools, Dr Sami Richa (Chef du Département de Psychiatrie à la Faculté de Médecine et à l’Hotel Dieu de France) stated that homosexuality was only removed from the “DSM-IV” (Diagnostic and Statistical Manual of Mental Disorders) because of lobbying by LGBTQ organizations. In his opinion, these groups found a loophole to slip homosexuals out of the manual by demonstrating that LGBTQ individuals find no trouble integrating in society (unlike schizophrenia or other mental illnesses where individuals find trouble adhering to society). According to Richa, it is a social integration that is furthermore enhanced by the need of homosexuals to establish families or by adopting children (in some countries) which he refers to as “fantaisie”.

Richa is just one of many lecturers who educate medical students that homosexuality is against nature and who trains future physicians into adopting homophobia and heteronomativity into their clinical approach.

While many doctors still regard homosexuality as a mental disorder that needs to be treated and hence eventually cured, they are merely serving as solid grounds for a society that reinforces the misconception of homosexuality as a crime against nature. Their approach subjects a significant portion of our society to further marginalization and nourishes the injustice that feeds our health care system.

Health practitioners have a tremendous role to play in creating safe and discrimination-free environments for all their patients, and for LBTQ women in particular. Whether they are aware of it or not, their discourse shapes and defines society’s perception and normalization of sexuality and gender. The question that we’re left with is: Who should be monitoring physicians and holding them accountable for the messages they convey to their patients and peers?

– Contributed by Koi-Fish

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