AIDS in Lebanon

Unlike much of the Middle East, HIV infection patterns in Lebanon are increasingly mirroring those of the West.

Although HIV/AIDS is seen in most Middle Eastern countries as a broad-based, low-risk epidemic among heterosexuals that affects less than 1 percent of the population, the infection profile in Lebanon is realigning to include homosexuals, intravenous drug users, prison inmate and sex workers - the same at-risk populations as in the West.

"What we have been witnessing over the last five to eight years is a major shift of the epidemic towards the gay community," according to Dr. Jacques Mokhbat, one of Lebanon's leading HIV/AIDS specialists and founder of the Lebanese AIDS Society.

Infection rates among homosexual men have doubled for the past two years running, according to government figures. Now gays represent more than half of the new infections in Lebanon, compared to under one third two years ago.

"Most of the new HIV cases in Lebanon now are gay," said Georges Azzi, director of Helem, a gay-rights non-governmental organization located in Beirut. "There is a problem that we need to deal with."

Other high risk groups, including sex workers, prisoners and intravenous drug users, are starting to emerge as well as primary drivers of the epidemic in Lebanon.

Some of the shift is a result of the correction of a statistical bias as well as improvements made to patchy reporting mechanisms in the past. Social taboos surrounding sexuality also keep many people from getting tested for the virus.

Sexual revolution changes behavior among young people

The shift in infection patterns is also connected to changes in sexual behavior in Lebanon. Health experts say the country is undergoing a sexual revolution with young Lebanese engaging in sex at a younger age, before marriage, casually, with multiple partners and with partners of the same sex.

"Lebanon is having its sexual revolution amidst the HIV pandemic, so it's not fun," Mokhbat said, adding that he has seen a jump in positive HIV tests in his clinic.

Many of the people now being diagnosed with HIV are also younger than those seen in other Middle Eastern countries, Mokhbat said.

"They are generally younger than 25, so they didn't get out much to understand all the details of HIV," he added.

Lack of sex education

Sex education is almost non-existent in Lebanese schools, and there are few places where young, gay people can go to find out more about HIV/AIDS.

Helem, which offers information as well as free condom and lubricant packs, and free anonymous HIV testing, is the only organization of its kind in Lebanon and has become one of the busiest testing sites in the country.

The NGO has also started a testing and information van which travels around cruising areas in Beirut at night, distributing condoms, information and offering rapid HIV tests to homosexuals.

The government is working together with groups like Helem, funding part of their activities and delegating outreach work undertaken by the organizations. At the same time, Lebanon's National AIDS Program (NAP) is putting together a new plan aimed at emerging risk groups.

But the NAP has its hands tied in many respects. Government ads against HIV/AIDS have tended to speak in metaphors or use poorly drawn cartoon characters to communicate the dangers of unprotected sex. More recent campaigns have been more explicit, but none yet acknowledges or targets homosexuals.

Law prohibits homosexuality

A law prohibiting homosexual acts in Lebanon is proving to be a major stumbling block as the country tries to adapt its health policy to the evolving shape of its HIV/AIDS epidemic.

Statistics show that the work of the government and Helem is stemming a growing tide. Like Mokhbat from the Lebanese AIDS Society, many experts think that now is the time for a fundamental overhaul in public health policy and legislation regarding homosexuality in Lebanon.

It will be important to change the law, Mokhbat said, but that, is not enough: "The important thing is to also change the social attitude."

Author: Don Duncan (ar)

Editor: Sean Sinico