On April 17, 2014, the US Food and Drug Administration FDA issued a safety communication titled: “Laparoscopic Uterine Power Morcellation in Hysterectomy and Myomectomy: FDA Safety Communication”

FDA logo - Dr. Hasan AbdessamadIn brief it states:

If laparoscopic power morcellation is performed in women with unsuspected uterine sarcoma, there is a risk that the procedure will spread the cancerous tissue within the abdomen and pelvis, significantly worsening the patient’s likelihood of long-term survival. For this reason, and because there is no reliable method for predicting whether a woman with fibroids may have a uterine sarcoma, the FDA discourages the use of laparoscopic power morcellation during hysterectomy or myomectomy for uterine fibroids.

The FDA recommends the following for Health Care Providers:

  • Be aware that based on currently available information, the FDA discourages the use of laparoscopic power morcellation during hysterectomy or myomectomy for the treatment of women with uterine fibroids.
  • Do not use laparoscopic uterine power morcellation in women with suspected or known uterine cancer.
  • Carefully consider all the available treatment options for women with symptomatic uterine fibroids.
  • Thoroughly discuss the benefits and risks of all treatments with patients.
  • Forindividual patients for whom, after a careful benefit-risk evaluation, laparoscopic powermorcellationis considered the best therapeutic option:
    •  Inform patients that their fibroid(s) may contain unexpected cancerous tissue and that laparoscopic power morcellation may spread the cancer, significantly worsening their prognosis.
    • Be aware that some clinicians and medical institutions now advocate using a specimen “bag” during morcellation in an attempt to contain the uterine tissue and minimize the risk of spread in the abdomen and pelvis.

The FDA recommends the following for Womyn:

  • Ask your health care provider to discuss all the options available to treat your condition and discuss the risks and benefits of each.
  • If laparoscopic hysterectomy or myomectomy is recommended, ask your health care provider if power morcellation will be performed during your procedure, and to explain why he or she believes it is the best treatment option for you.
  • If you have already undergone a hysterectomy or myomectomy for fibroids, tissue removed during the procedure is typically tested for the presence of cancer. If you were informed these tests were normal and you have no symptoms, routine follow-up with your physician is recommended. Patients with persistent or recurrent symptoms or questions should consult their health care provider.

AAGL logo - Dr. Hasan Abdessamad

The first response came from the American Association of Gynecologic Laparoscopists (AAGL):

The AAGL is reviewing the scientific evidence and best practices reported by our members to provide readily accessible, comprehensive information to our members… We encourage our members to fully research and understand the risks of power morcellation and to learn more about when alternative methods of tissue extraction may be appropriate.

AAGL is establishing a task force to address this emerging evidence.

The FDA is convening a public meeting of the Obstetrics and Gynecological Medical Device Advisory Committee to provide better guidance to manufacturers and physicians. 

Until we get better guidance from our medical associations and a consensus from experts in the field, my counselling to patients will include this rare complication. I will state the risk quoted by FDA: “it is estimated that 1 in 350 women undergoing hysterectomy or myomectomy for the treatment of fibroids is found to have an unsuspected uterine sarcoma, a type of uterine cancer that includes leiomyosarcoma.” Even though, I wish their statement included a reference to the original research from which the 1/350 figure was obtained.

Uterine sarcomas are extremely rare. I do not recall coming across any case in my training or practice. There was one case of a leiomyosarcoma in my family that developed years after an open hysterectomy with no morcellation. The quoted incidence of uterine sarcomas is 0.36 per 100,000 woman-years in the United States (US) from 1979 to 2001, or 3 to 7 per 100,000 US population from 1989 to 1999, based on data from the Surveillance, Epidemiology and End Results national cancer database according to UpToDate’s “Uterine sarcoma: Classification, clinical manifestations, and diagnosis” that was last updated on Jan. 28th 2014.

Even though this statement might seem to hinder our efforts to provide gynecological minimally invasive surgery to a larger number of womyn, I believe it will only improve our performance. This will encourage surgeons to adopt new techniques that mitigate the risk (even if small), like morcellating within a bag, wether power or manual, wether abdominal or vaginal.

LIGO logo - Dr. Hasan Abdessamad

I will be a suturing preceptor at the Laparoscopic Institute for Gynecology and Oncology (LIGO) Masters’ Course in Laparoscopic Surgery in San Francisco, California, USA from May 15 to 17, 2014. I will update you on the general consensus among LIGO experts. I am sure this will be a highly debated/discussed topic.

For now, and until further evidence or guidance arises, I will continue to offer the option of power morcellation to adequately selected and appropriately counselled patients who wish to avoid the morbidity of an open procedure (the traditional route of hysterectomy using a large abdominal incision, also called abdominal hysterectomy or laparotomy) and in whom power morcellation is the only feasible option that allows for a minimally invasive surgery.


Today the World Bank Group hosted a roundtable of civil society organizations (CSO) with the Bank’s executive directors (ED).

I was representing the Lebanese Medical Association for Sexual Health (LebMASH). We were amongst 18 CSOs from all around the globe.

Dr. Hasan Abdessamad at World Bank Meetings

CSO leaders from Poland, Lebanon, India, Philippines, Brazil, China and Russia (Left to Right)

Many issues and concerns were raised: A decline in fishermen’s yield in Gujarat, India due to a coal plant, a power plant installation failure in Albania, a “disastrous” investment of the World Bank in Chad among others. The most interesting addition to this year’s CSO involvement is the loud buzz about human rights protection inclusive of gender, sexual orientation, gender identity and gender expression. The gender and SOGIE (Sexual orientation and gender identity/Expression) coalition were able to get three questions through to the ED panel. Two questions about SOGIE were asked by Altin Hazizaj from Pink Embassy in Albania and Jonas Bagas from TLF Share Collective in the Philippines. One question about gender was asked by Andrea Quesada from WEDO in Costa Rica.

CSO Roundtable with World Bank Executive Board

CSO roundtable with World Bank EDs

Merza Hasan, Kuwaiti national and ED of most of the MENA (Middle East and North Africa) region including Lebanon, had the first response: “It is not an easy discussion” he shrugged the question with a laugh as he deferred it to Germany’s ED.

I tried to paraphrase the responses of different EDs to those questions.

Ingrid G. Hoven, ED representing Germany, responded as follows:

We are at beginning of a learning process. We have to invest in getting the right expertise in place. We have to be more knowledgeable about the situation on the ground. I am comparing the current situation to that we faced 15 years ago when we addressed HIV. If we look back at how we initially handled the issue, we would be embarrassed. We need to hear their voices to gain better insight about their needs. We, at the Bank, are embarking on this learning process on LGBT rights and we are discussing internally to deal with this issue more appropriately. We need to discuss social inclusion when we address development.

She added:

By the time we meet again at the annual meeting we would be ready with a better answer.

Introducing myself to Mr. Merza Hasan.

Introducing myself (far left) to Mr. Merza Hasan (middle). Victoria Tauli Corpuz (far right)

Victoria Tauli Corpuz

Satu-Leena Santala, Finnish national and ED representing mostly Nordic countries, said:

The World Bank came a long way in promoting women’s right, but it is not enough, I feel we need to do more to achieve a better/different reality.

On Gender safeguards she added:

Safeguards are there to make sure we do no harm, but that is not enough, we should be promoting well being of women and that is why I am against having gender safeguards. I am also careful not to overload our safeguards and to find more practical ways to address this issue.

Sara Margalit Aviel, alternate ED for USA, said:

Social inclusion and rights are key to development and the Bank should learn to start addressing them. We need to assess who is marginalized, social assessment should be upfront before project implementation not only throughout the process. We need to predict and identify affected communities in order to mitigate harm.

Linking the Bank’s current motto: “End Poverty” to the marginalized groups, she concluded:

Poverty is about exclusion.

Rogério Studart, Brazilian national and the alternate ED for Brazil, the Philippines et al., called for a “revolution” within the Bank. Even when he was answering a question about the environmental footprint of the World Bank, he strayed to include sexual orientation and gender identity in his call for inclusion of all human rights.

Victoria Tauli Corpuz, Director of Indigenous Peoples’ International Centre for Policy Research and Education in the Philippines, also spoke about social inclusion and mentioned LGBT individuals as part of marginalized groups.

We will not get very far without including marginalized groups and focusing on sustainability.

Merza Hasan concluded by mentioning three focus points of the executive board: “selectivity, transformation and impact.” and provided a generic advice to all CSOs: “Honestly, when I go back home to my country and sit with CSOs, I want to hear a unified voice.”

“Unify your voices” he says! Was he throwing the Bank’s responsibility back at the civil society? Did he ask for a single voice as it would be easier to bureaucratically handle instead of a roar of multiple voices? Was he asking for the impossible? How is the fisherman in Gujarat, India, expected to reach out to the civil society in Chad or Albania? Did he ask us to unify our voices about the plethora of environmental, social, gender and sexual issues impacted by Bank’s policies to present it in a simplified single-issue voice?

I am pleased that Mr. Hasan agreed to meet with me tomorrow. I am looking forward to carrying a constructive discussion on how we can best serve the marginalized in our societies in Lebanon and the MENA region, as we serve the mission statement of the Bank to “End Poverty” by abolishing all kinds of discrimination inclusive of gender and SOGIE.


It is always a delight when my patients bring their newborns to their office follow up appointments. Elsie is now 1 month and she had a blessed journey into this world.

20140403-142358.jpg


323 health and human rights non-governmental organizations from 89 countries appeal to the World Health Organization’s WHO Director-General, Dr. Margaret Chan, to continue her negotiations to prevent the removal of an LGBT (lesbian, gay, bisexual, transgender) health item from the WHO executive board meeting in May 2014.

Efforts to remove the item are lead by Egypt from the EMRO (East Mediterranean Regional Office) and Nigeria from AFRO (African Regional Office). 59 organizations from AFRO and 8 from EMRO (5 of which are from Lebanon) have signed the letter.

On March 12, 2014, the following letter was sent:

Dear Madam Director General:

We, the undersigned civil society organizations from all regions of the world, respectfully write to you today to show our support for the complicated work you have undertaken of finding consensus on how to discuss issues related to access to health for lesbian, gay, bisexual, and transgender (LGBT) individuals. We are dismayed that the topic has become so contentious and difficult to discuss, but we write to encourage you to persevere and bring these very important and appropriate health concerns to the work of the World Health Organization.

We represent a variety of health, HIV, human rights, and LGBT organizations which all work in some manner on the real impact of discrimination against individuals based on actual or perceived sexual orientation and gender identity. This discrimination is rampant in all of our societies, despite differences of culture, economics, politics, or legal status of homosexuality. Such discrimination directly impacts the health outcomes of these communities. Whenever any group of people—no mater how marginalized—experience disparate health outcomes, that is of legitimate interest to the WHO and deserves to be studied and understood fully. We appreciate that you have personally taken the time to ensure that the Executive Board of the WHO will address these issues appropriately.

As you know, reports from every region of the world show that LGBT citizens lack equal access to health care, and experience real discrimination based on exposing their sexual orientation, sexuality, gender identity, gender expression, or bodily diversity in health care settings. Such discrimination takes many different forms including outright denial of services, harassment, embarrassment, violence and arrest, as well as internalized stigma and shame. Such experiences lead directly and indirectly to bad health outcomes, such as higher incidents of depression, drug and alcohol use, lack of HIV prevention and treatment, and even suicide. Cancer-related health disparities for lesbian women have been indicated in a variety of studies, and transgender individuals receive particularly poor or no appropriate health services specific to their needs.

We write today to encourage continued dialogue and discussion of these important health matters, and to make sure that the item does not get permanently postponed or deleted from the agenda of the Executive Board. We further urge the Secretariat of WHO to engage in further study and research on the health outcomes for LGBT communities in all parts of the world, since a disproportionate amount of existing data comes from Global North countries. It is imperative that the WHO encourage thoughtful and unbiased study in all regions of the world.

This is an important moment in the evolution of global health to address the particular health challenges of LGBT populations.  This is indeed a critical next step for WHO to help improve the vital and universal access to health for LGBT people.

Should there be anything we can do to support this effort, please let us know.

With respect and hope for a healthier world,

WHO World Health Organization Dr. Hasan Abdessamad

The following organizations have signed the letter:

WHO Western Pacific Region Australia Australian Federation of AIDS Organisations, Australia
Australian Transgender Support Association of Queensland, Australia
Bisexual Alliance Victoria, Australia
Brisbane LGBTIQ Action Group, Australia
Changeling Aspects, Australia
FTM Shed, Australia
Gay & Lesbian Welfare Association, Australia
Positive Life NSW, Australia
Queensland AIDS Council, Australia
The National LGBTI Health Alliance, Australia
Transgender Victoria, Australia
Victorian Gay and Lesbian Rights Lobby Inc, Australia
Western Australian AIDS Council’s Freedom Centre, Australia
ACON, Australia
China Ark of Love, China
Beijing Gender Health Education Institute, China
Chengdu Tongle Health Counseling Service Center, China
China Alliance of People Live With HIV/AIDS (CAP+), China
China LGBT/HIV Youth Network (U&I Club), China
TransgenderASIA, China
Fiji Amithi Fiji Project, Fiji
Japan Space Allies, Japan
Malaysia myPLUS, Malaysia
PT Foundation, Malaysia
Mongolia Youth For Health, Mongolia
New Zealand ITANZ, New Zealand
OUTLineNZ Inc., New Zealand
Rainbow Youth, New Zealand
Philipinnes Family Planning Organization of the Philippines, Philippines
Gender and Development Advocates (GANDA) Filipinas, Philippines
Women’s Global Network for Reproductive Rights (WGNRR), Philippines
Youth Peer Education Network (Y-PEER) Pilipinas Inc., Philippines
Waray-Waray Youth Advocates (WARAYA), Philippines
Singapore FTM Asia, Singapore
Oogachaga, Singapore
Pink Crane Project, Singapore
Project X, Singapore
The G Spot, Singapore
Tonga Pacific Sexual Diversity Network, Tonga
Tonga Leitis’ Association, Tonga
Vietnam Center for Supporting Community Development Initiatives, Vietnam
WHO Eastern Mediterranean Region Lebanon Helem, Lebanon
Lebanese Medical Association for Sexual Health LebMASH, Lebanon
Oui Pour la Vie, Lebanon
Proud Lebanon, Lebanon
The Arab Foundation for Freedoms and Equality AFE, Lebanon
Morocco ALCS, Morocco
Association Marocaine des droits de l’Homme, Morocco
Sudan Bedayaa, Sudan
WHO European Region Armenia PINK Armenia, Armenia
Belgium European AIDS Treatment Group, Belgium
Exaequo, Belgium
International Lesbian Gay Bisexual Trans and Intersex Association (ILGA) Europe, Belgium
Sensoa, Belgium
Transgender Info Point, Belgium
Czech Czech AIDS Help Society, Czech Republic
Estonia ECOM – Eurasian Coalition on Male Health, Estonia
Finland Drodrolagi Movement, Finland
France AIDES, France
Les Dègommeuses, France
Germany Aktion Transsexualität und Menschenrechte e.V., Germany
Berliner Aids-Hilfe e.V., Germany
Transgender Europe (TGEU), Germany
Latvia Association of LGBT and Their Friends MOZAIKA, Latvia
Society Association HIV.LV, Latvia
Macedonia Health Education and Research Association, Macedonia
Moldova Genderdoc-M, Moldova
Montenegro LGBT Forum Progress, Montenegro
Netherlands Aids Fonds, Netherlands
Norway Ressursgruppe for Transpersoner (RfT), Norway
Poland Trans-Fuzja Foundation, Poland
Romania Independence Zone, Romania
Population Services International, Romania
TRANSform, Romania
Russia Ageeva Anastasia, Russia
FTM Phoenix Group, Russia
LGBT organization (Rakurs), Russia
menZDRAV Foundation, Russia
Phoenix PLUS, Russia
Positive Wave Foundation, Russia
Samara LGBT Movement Avers, Russia
Siberia-AIDS-Aid, Russia
Serbia Gayten-LGBT, Serbia
Q-Club, Serbia
Slovakia TransFuzia, Slovakia
DIH – Equal Under the Rainbow, Slovenia
ŠKUC-Magnus, Slovenia
Spain Conjuntos Difusos – Autonomía Trans, Spain
Fundación Triángulo, Spain
Sweden Pride Sports Africa, Sweden
Switzerland Association 360, Switzerland
Dialogai, Switzerland
Pink Cross, Switzerland
Winters Consulting, Switzerland
Swiss AIDS Federation, Switzerland
Tajikistan Equal Opportunities, Tajikistan
United Kingdom AVERT, United Kingdom
BHA for Equality in Health and Social Care, United Kingdom
HIV Justice Network, United Kingdom
London School of Hygiene & Tropical Medicine, United Kingdom
Nigeria Association of LGBT’s Abroad, United Kingdom
Rainbow Intersection, United Kingdom
Reproductive Health Matters, United Kingdom
Social Work & Health Inequalities Network, United Kingdom
Support Acceptance Information Learning (SAIL), United Kingdom
TransForum Manchester, United Kingdom
Ukraine International HIV/AIDS Alliance in Ukraine, Ukraine
menZDRAV Foundation, Ukraine
Uzbekistan XS (Access), Uzbekistan
WHO Region of the Americas Argentina Asociación Internacional de Lesbianas, Gays, Bisexuales, Trans e Intersex para AmÈrica Latina y el Caribe (ILGALAC), Argentina
Comunidad Homosexual Argentina (CHA), Argentina
Fundación para Estudio e Investigación de la Mujer, Argentina
Global Action for Trans* Equality (GATE), Argentina
Grupo de Mujeres de la Argentina, Argentina
Proyecto Educar en la Diversidad Sexual sin Homofobia, Lesbofobia, Bifobia ni Transfobia de la Escuela de Educación Media N° 20 de La Plata, Argentina
Belize United Belize Advocacy Movement, Belize
Bolivia Catolicas por el Derecho a Decidir/Bolivia, Bolivia
Fundación Diversencia, Bolivia
Manodivera Asociacion Civil, Bolivia
Brazil Latin American Centre on Sexuality and Human Rights, Brazil
PIM, Brazil
Canada African and Black Diaspora Global Network on HIV/AIDS, Canada
AIDS Action Now!, Canada
AIDS Committee of Simcoe County, Canada
Canadian HIV/AIDS Legal Network, Canada
Canadian Treatment Action Council, Canada
Canadian Union of Public Employees (CUPE), Canada
Canadian AIDS Treatment Information Exchange, Canada
Global Network of People Living with HIV/AIDS North America, Canada
ILGA North America, Canada
Interagency Coalition on AIDS and Develpment (ICAD), Canada
Office of Global Health, Canada
Ontario Federation of Labour, Canada
Particular, Canada
The SHARP Foundation, Canada
United Food and Commercial Workers (UFWC), Canada
Unite Here Local 75, Canada
Chile Fadise Chile, Chile
Organización de Transexuales por la Dignidad de la Diversidad, Chile
Traveschile, Chile
Colombia ATSMAG, Colombia
La Fundación Azul, Colombia
Costa Rica CIPAC, Costa Rica
Dominica MiRiDom, Dominica
Dominican Republic Coin, Dominican Republic
Grupo Este Amor, Dominican Republic
La Candel, Junta Lèsbica, Dominican Republic
Transsa, Dominican Republic
Ecuador ACDemocracia, Ecuador
Asociación Silueta X, Ecuador
Grupo de Ayuda Mutua (Caminos de Esperanza), Ecuador
Luna Creciente, Ecuador
El Salvador Centro LGBT San Miguel, El Salvador
ICM El Salvador, El Salvador
Guatemala Asociación Colectivo Amigos contra el Sida, Guatemala
Red Nacional de Diversidad Sexual y VIH de Guatemala, Guatemala
Guyana Artisites in Direct Support, Guyana
Gay Pride Guyana, Guyana
Haiti SEROvie, Haiti
Honduras Asociacion Para Una Vida Mejor de Personas Infectadas-Afectadas por el VIH-Sida en Honduras, Honduras
Cattrachas Organizacion Lesbica Feminista, Honduras
Cattrachas Tegucigalpa, Honduras
Mexico Balance Promoción para el Desarrollo y Juventud A.C., Mexico
Centro de Desarrollo e Investigación sobre Juventud A.C., Mexico
CESSEX, Mexico
Closet de Sor Juana, Mexico
Colectivo Sol A.C., Mexico
Consorcio para el Diálogo Parlamentario, Mexico
DHIA A.C., Mexico
Fundacion Arcoiris por el Respeto a la Diversidad Sexual, Mexico
Interculturalidad Salud y Derechos A.C. (INSADE), Mexico
Investigaciones Queer A.C., Mexico
IpasMéxico A.C., Mexico
No Dejarse es Incluirse. A.C., Mexico
Odesyr Observatorio Ciudadano de Derechos Sexuales y Reproductivos A.C., Mexico
Programa CompaÒeros A.C., Mexico
Salud Integral para la Mujer A.C., Mexico
Vihda a Favor de la Vida A.C., Mexico
Espolea, Mexico
Nicaragua Centro de Información y Servicios de AsesorÌa en Salud, Nicaragua
Gropo Lésbico Feminista Artemisa, Nicaragua
Grupo Safo, Nicaragua
Iniciativa desde la Diversidad Sexual por los Derechos Humanos, Nicaragua
Paraguay Campaña por la Convención Interamericana de los Derechos Sexuales y Derechos Reproductivos, Paraguay
SOMOSGAY, Paraguay
Peru Agrupacion de Travestis Las Mil Manios de la Solidaridad, Peru
Asociación Civil CAMBIO y ACCI’N., Peru
Asociación Civil Impacta Salud y Educación, Peru
PROMSEX, Peru
Puerto Rico Coai Inc., Puerto Rico
Taller Lesbico Creativo, Puerto Rico
Suriname Women’s Way Foundation, Suriname
Uruguay Articulación Feminista Marcosur, Uruguay
USA AIDS Community Research Initiative of America, United States of America
AIDS Project of the East Bay, United States of America
American Jewish World Service, United States of America
amfAR the Foundation for AIDS Research , United States of America
APHA LGBT Caucus of Public Health Professionals, United States of America
Asia Catalyst, United States of America
Callen-Lorde Community Health Center, United States of America
Center Global a program of the DC Center for the LGBT Community, United States of America
Communit Service Network Inc, United States of America
Council for Global Equality, United States of America
Fenway Health, United States of America
Gay Men of African Descent Inc., United States of America
GLMA: Health Professionals Advancing LGBT Equality, United States of America
Global Youth Coalition on HIV/AIDS, United States of America
GreeneWorks, United States of America
Health and Human Rights Law Project – University of California Los Angeles School of Law, United States of America
HIV Prevention Justice Alliance (HIV PJA), United States of America
International Center for Research on Women, United States of America
International Gay and Lesbian Human Rights Commission (IGLHRC), United States of America
International HIV/AIDS Alliance, United States of America
International Rectal Microbicide Advocates, United States of America
Lesbian Health Initiative, United States of America
MSMGF, United States of America
National LGBT Cancer Network, United States of America
National Youth Pride Services, United States of America
Northwest Florida AIDS Consortium, United States of America
Pangaea, United States of America
PROMO Fund, United States of America
Rainbow Health Initiative, United States of America
San Francisco AIDS Foundation, United States of America
Soulspiritus, United States of America
University of Minnesota HIV/STI Intervention and Prevention Studies (HIPS) Program, United States of America
United Food and Commercial Workers OUTreach, United States of America
Weill Cornell Center for Human Rights, United States of America
Venezuela Dhayana Carolina Fernandez Matos, Venezuela
Fundación Reflejos de Venezuela, Venezuela
Gente Rara, Venezuela
Orgullo Guayana, Venezuela
Trabajador Cultural, Venezuela
Venezuela Diversa A.C, Venezuela
ACCSI Acción Ciudadana Contra el SIDA, Venezuela
WHO African Region Algeria AnisS, Algeria
Botswana Pilot Mathambo Centre for Men’s Health, Botswana
Burundi Mouvement pour les Libertés Individuelles, Burundi
Rainbow Candle Light, Burundi
Together for Women’s Rights, Burundi
Côte d’Ivoire Renaissance Santè Bouakè, Côte d’Ivoire
Unis pour Sauver des Vies, Côte d’Ivoire
DRCongo CONERELA+, Democratic Republic of the Congo
Youth Coalition Plus on MDGs Achievement, Democratic Republic of Congo
Ethiopia Rainbow-Ethiopia Health and Rights Initiative, Ethiopia
Ghana Centre for Popular Education and Human Rights Ghana, Ghana
Community and Family Aid Foundation, Ghana
Communication for Social Change Ghana, Ghana
Guinea Afrique arc-en-ciel Guinée, Guinea
Kenya Gay & Lesbian Coalition of Kenya (GALCK), Kenya
ISHTAR-MSM, Kenya
Kenya Medical Research Institute, Kenya
Kydesa Rainbow Community, Kenya
Let Good Be Told In Us (NYARWEK Coalition), Kenya
Men Against AIDS Youth Group, Kenya
PEMA Kenya, Kenya
Tamba Pwani C.B.O, Kenya
Upper Rift Minprite, Kenya
Malawi Centre for the Development of People, Malawi
CHISA Malawi, Malawi
Ladder for Rural Development, Malawi
Northern Youth Network, Malawi
Mauritania AGD, Mauritania
Mauritius Collectif Arc-en-Ciel, Mauritius
Namibia DMC Services, Namibia
Nigeria Initiative for Improved Male Health, Nigeria
IRMA Nigeria, Nigeria
Marps Behavioral Initiative, Nigeria
Network of People Living with HIV/AIDS Nigeria (NEPWHAN), Nigeria
New HIV Vaccine and Microbicide Advocacy Society, Nigeria
Women’s Health and Equal Rights Initiative, Nigeria
The Initiative For Equal Rights, Nigeria
Pan Africa Pan Africa ILGA, Africa
South Africa African Men for Sexual Health and Rights (AMSHeR), South Africa
AIDS & Rights Alliance for Southern Africa, South Africa
Anova Health Institute, South Africa
Buwa Project, South Africa
Desmond Tutu HIV Foundation, South Africa
Health and Development Africa, South Africa
ICAP-SA, South Africa
International Centre for Aids Care and Treatment Programmes, South Africa
NACOSA, South Africa
People’s Health Movement, South Africa
TC productions, South Africa
Tanzania LGBT Voice Tanzania, Tanzania
Tanzania Sisi Kwa Sisi Foundation, Tanzania
Uganda Community Uplift, Uganda
COPI, Uganda
Freedom and Roam Uganda, Uganda
Spectrum Uganda Initiatives Inc., Uganda
Zambia Envision, Zambia
Friends of Rainka – Medical Consultancy, Zambia
Zambia Association for the Prevention of HIV and TB, Zambia
Zimbabwe GALZ, Zimbabwe
WHO South-East Asia Region Bangladesh Bandhu Social Welfare Society, Bangladesh
Bangladesh Institute of Human Rights, Bangladesh
JusticeMakers Bangladesh, Bangladesh
Village Integreted Development Association (VIDA), Bangladesh
India Astitva Trust, India
India HIV/AIDS Alliance, India
International Association of Schools of Social Work, India
Lakshya Trust, India
Mission for Indian Gay & Lesbian Empowerment (MINGLE), India
SWASTI, India
The Humsafar Trust, India
University of Calcutta, India
Indonesia Fokus Muda–Indonesian Young Key Populations Forum, Indonesia
Gaya Nusantara, Indonesia
GWLmuda, Indonesia
Youth Coalition for Sexual and Reproductive Rights, Indonesia
Nepal Blue Diamond Society, Nepal
Dautari Nepal, Nepal
Sri Lanka People’s Health Movement, Sri Lanka
Thailand Anjaree Foundation, Thailand
Asia Pacific Coalition on Male Sexual Health (APCOM), Thailand
Health and Opportunity Network, Thailand
National Health Commission Office, Thailand
Phakwilai Sahunalu/Anjaree Foundation, Thailand
Population Services International, Thailand
Youth LEAD, Thailand
Youth Voices Count, Thailand
Global Organizations Global AVAC, Global
Human Rights Watch, Global
International Lesbian Gay Bisexual Trans and Intersex Association (ILGA), Global

Here is a related article from this blog:


A year ago, LebMASH (Lebanese Medical Association for Sexual Health) was consulted on an issue regarding a direction to include LGBT (lesbian, gay, bisexual, transgender) health issues within the work of the WHO (World Health Organization).

WHO - World Health Organization - Dr. Hasan Abdessamad

Two member states requested to add an LGBT health item to the agenda of the Executive Board of the WHO meeting in Geneva in May 2013. (Suggested item 6.3 of the this April 2013 draft of the agenda – PDF)

LebMASH was approached since Lebanon is a member state of the WHO Executive Board  (till 2015). “I’m curious if you think your government could possibly be moved from hostile to neutral on the issues?” we were asked in the first communication.

Hostile! I personally agree, hostile in a passive aggressive way. Our government understands well the outcome of societal stigmatization on the health of marginalized groups. Our Ministry of Health has already been working with Helem (Lebanon’s LGBT organization) for a decade. The Lebanese Psychiatric Society (LPS) and Lebanese Psychological Association (LPA) have both adopted LebMASh’s position statement stating that homosexuality is not a disease. Both LPS and LPA came out strong against SOCE (Sexual Orientation Change Efforts). Only few days ago, a judge ruled that article 534 of the Lebanese penal code couldn’t be applied to criminalize homosexuals since their sexual act is not “against nature”.

Lebanon has no reason to vote negatively on adding an LGBT health item to the WHO Executive Board Agenda.

Our sources from a meeting within WHO walls in Geneva informed us that Lebanon sympathizes with the issue and understands the importance of adding this item to the agenda but cannot break out of the vote of the EMRO region block.

Politics! As if we do not suffer enough of it back home corrupting our daily lives, paralysing our progress and threatening our security, now we see it carried out beyond our borders to impact global health policies.

Last I checked, my doctor’s Hippocratic Oath said “do no harm” and not vote with the block.

Lebanon should play a vital role within the EMRO region to sway the vote of the block and relay the importance of adopting inclusive health care policies so member countries can advance health care instead of oppressing minorities.

This whole debate was concealed from the media for the past year. The only mention of it was a post (not even an article) in an Egyptian online paper on May 31 2013. The title translates to “Egypt removes ‘Advancing LGBT health care’ item from WHO agenda.” and quotes Egypt’s Health Minister stating that “the opposition to the inclusion of the topic was becasue being gay is ‘contrary’ to religious, cultural, moral, and social values.”

The media should allow the public to know about what has been brewing behind closed doors at the WHO. Discrimination in health care should not be tolerated.

Here is what you need to know:

  • The EMRO (Regional WHO office for Eastern Mediterranean) and AFRO (Regional WHO office for Africa) blocks within the Executive Board of the WHO object categorically to the inclusion of any items relating to LGBT health on the WHO agenda. They veto the inclusion of the item even before even discussing what the item will be discussing.
  • The next scheduled meeting is in May 2014. Efforts are still underway to add the item to the agenda.
  • Dr. Margaret Chan, the Director-General of WHO, has been negotiating to find consensus on how to best address the inclusion of this needed discussion.

Here is what you can do:

  • Reach out to human and health rights organizations within your country and recruit their support.
  • If your country is on the list of current Executive Board Members of WHO, try to reach out to the representative of your country and let them know your or your organization’s position on the issue.
  • Raise awareness by spreading the story among colleagues and contacts.
  • Help create a buzz by privately emailing to journalists/bloggers or publicly sharing with or tweeting to media.
  • Sign On for WHO Consensus on LGBT Health! Invite your organization to sign the petition before March 10th, 2014.
  • Send your suggestions of how you believe this issue should be approached in Lebanon (and the EMRO and AFRO regions) to info@lebmash.org

Health care is a right, we should not allow it ever become a privilege.


Dr. Hasan Abdessamad:

Recently the Lebanese Medical Association for Sexual Health has collaborated with Kafa, an organization that advocates against “Violence & Exploitation” of womyn in Lebanon, to establish a series of workshops on mental health and sexuality. The sessions are generally interactive and depend on feedback from participant to guide the content.

The first session was given by Dr. Hala Kerbage, a psychiatry resident and an active LebMASH partner. I am reblogging here what Dr. Kerbage wrote for LebMASH blog about her session.

The second session was given on Feb 28 by Dr. Sally Khoury, an Obstetrics & Guynecology resident at the American University of Beirut. Dr. Khoury discussed sex and sexuality with a Kafa group of victims of physical and sexual abuse.

Originally posted on Lebanese Medical Association for Sexual Health:

On Jan. 9 th  2014, the Lebanese Medical Association for Sexual Health provided an educational session about depression and some of its features in the female gender to women from KAFA (Enough Violence and Exploitation), an NGO aiming at fighting gender based violence and advocating for women’s rights in Lebanon and the Middle East.

The presentation was an interactive one where most of the participants talked about their own experience with depression. Symptoms of depression were explained, as well as the difference with transient sad mood. The presentation also dealt with the etiologies of depression, and the risk factors especially in the post-partum period.

Another section of the presentation was about management of depression, and the participants had many questions about antidepressants and tranquilizers: difference between them, delay of action, side effects, duration of treatment. Other aspects of depression management were also explained, with an emphasis on psycho-social support.

Finally, a video…

View original 28 more words


The Lebanese Medical Association for Sexual Health (LebMASH) calls on students in any medical field who are interested in sexual health and LGBT (Lesbian, Gay, Bisexual and Transgendered) health to apply for the second annual Break the Silence” academic paper competition.

LebMASH Break The Silence competition

Students are invited to:

  1. Write an academic quality paper of a maximum of 1500 words on any issue related to either women’s sexual health or LGBT health in Lebanon.
  2. Submit the paper along with a CV and contact info to: info@lebmash.org

The deadline for submissions is Friday June 20, 2014 at midnight. 

At the end of the competition, LebMASH executive board members will review all submissions and select one winner who will be granted a trip (Up to max of  1500 USD) to Baltimore, Maryland, USA to attend GLMA’s (Health Professionals Advancing LGBT Equality) annual conference that will take a place from Sep 10 to 13, 2014.

GLMA annual conference

LebMASH will help the student publish her/his work in a peer-reviewed medical journal. LebMASH will also publish a French and Arabic translation of the winning paper on lebmash.org.

Break The Silence Competition LebMASH


I was invited to speak about my work with the Lebanese Medical Association for Sexual Health at the GLMA annual conference in Denver in Sept. 2013. An editor from LGBT Health peer-reviewed medical journal was among the audience. After the presentation, the editor invited me and Dr. Omar Fattal, with whom I was presenting, to write an article about what we presented to be considered for publication.

I just learned that the article was accepted for publication and Mary Ann Liebert Inc. Publishers has made it available online to the public and “Ahead of Print” on Jan 29 2014.  I will share the full length here.

ABSTRACT
Omar Fattal, MD MPH

Dr. O. Fattal

Dr. Hasan Abdessamad Vancouver Obstetrician Gynecologist OBGYN

Dr. H. Abdessamad

Lebanon is considered relatively liberal, but Lebanese lesbian, gay, bisexual, and transgender (LGBT) individuals continue to face social and legal challenges. Homophobia is common among health-care providers. Only 50% of physicians in a study were willing to “tend the medical needs” of homosexuals. Homosexuality is still perceived as a disease and the practice of reparative therapy is common. Programs focusing on sexual health are scarce, with only a few being LGBT-friendly. For Lebanese LGBT individuals, there remains a significant gap in access to health care. The Lebanese Medical Association for Sexual Health (LebMASH) was established to address this gap.

Introduction

In the past several years, we have noticed a trend in the West that depicts Lebanon as a gay-friendly destination. For example, The New York Times published an article in 2009 titled, “Beirut, the Provincetown of the Middle East.”1 In reality, even though Lebanon is more liberal than other Arab countries when it comes to lesbian, gay, bisexual, and transgender (LGBT) rights, Lebanese LGBT individuals face significant social and legal challenges.

Article 534 of the Lebanese penal code states: “Any sexual intercourse contrary to the order of nature is punished by imprisonment for up to one year.” This article has been widely used in recent years to criminalize a variety of consensual male and female homosexual relationships. It has also been widely used to blackmail and intimidate LGBT individuals.2

Personal status and matters related to family law are under the jurisdiction of the religious court system. Christianity and Islam, the two biggest religions in Lebanon, have a large influence on the fabric of the society.

In general, homosexuality remains a social taboo, and in the past decade, Lebanon has witnessed a crackdown on the LGBT community. For instance, in July 2012, 36 individuals were arrested in a movie theater that caters to the clientele of men who have sex with men (MSM) in Beirut.3 In April 2013, a popular gay nightclub in a Beirut suburb was shut down by the local municipality. Several people were arrested and exposed to verbal, physical, and sexual abuse. Nude photographs of detainees were leaked to social media.4 In June 2013, Human Rights Watch (HRW) released a report detailing the ill treatment of vulnerable populations, including LGBT individuals, by Lebanese internal security forces.5

These legal, social, and religious factors create a climate of fear and intimidation with several negative outcomes such as hindering LGBT individuals from coming out to friends and family as well as to their health-care providers.

Background on LGBT Health

The literature on LGBT health in Lebanon is very scarce. In a study that was conducted in 2010, 73% of surveyed physicians believed that homosexuality is a disease and only 50% were willing to “tend the medical needs” of a homosexual patient.6

Forensic physicians are known to perform anal tests that involve the insertion of an egg-shaped object into the person’s anus to ascertain if someone is homosexual. This practice came to light on a large scale after the movie theater arrests in 2012 when 36 detainees were subjected to the test.7 The incident stirred outrage from several human rights groups. HRW published a report in August 2012 titled, “Lebanon: Stop ‘Tests of Shame.’”8 This outrage resulted in the Lebanese Order of Physicians issuing a strong statement condemning this practice.9

Furthermore, sexual orientation change efforts (SOCE) are still prevalent in Lebanon. There have been several verbal reports about the so-called Reparative or Conversion Therapy to Helem (Lebanon’s largest LGBT rights organization). Mental health professionals have spoken favorably about such practices publicly on TV.10

The past decade has witnessed a few efforts to improve LGBT health, although catered more toward MSM. These efforts mainly represent the work done by Helem, Soins Infirmiers et Dèveloppement Communautaire, and the Ministry of Health’s National AIDS Program to tackle HIV infection.11 In addition, Marsa was established in early 2011 as the first sexual health center in Lebanon. Marsa provides voluntary counseling and testing for HIV and comprehensive primary and secondary health-care services in an LGBT-affirmative environment.1112

Lebanese Medical Association for Sexual Health

Despite these efforts, the gap in access to health care for LGBT individuals in Lebanon remains very large. A group of Lebanese health-care professionals came together in September 2012 to create the Lebanese Medical Association for Sexual Health (LebMASH). LebMASH’s mission is to advance health care for LGBT individuals and sexual health for all individuals in Lebanon. LebMASH has the following objectives:

  • Spreading awareness and knowledge, as well as influencing attitudes and behaviors of health-care providers and the general public regarding LGBT health and sexual health
  • Influencing and changing policies and legislations in professional organizations, including schools, hospitals, and governmental agencies, to protect the health rights and well-being of LGBT individuals and sexual health of the general public
  • Advancing research regarding LGBT and sexual health
  • Supporting other organizations that provide health care to LGBT individuals and sexual health care

In the past year, LebMASH had several activities that fall under the following categories:

  • Raising awareness
  • Education
  • Advancing research
  • Advocacy
  • Encouraging professional development

Under the category of raising awareness, LebMASH has been vigilant in monitoring the Lebanese media for any appearances or reports that present inaccurate information on sexual or LGBT health. In June 2013, LebMASH published a reply to a pseudopsychologist who appeared in an interview on a major TV station and was noted to give wrong information on homosexuality.10
LebMASH also published a position statement on SOCE on May 17, 2013, to correct misconceptions regarding homosexuality.13 The statement urged “health care providers in Lebanon to refrain from this [SOCE] unethical and potentially harmful practice,” and called on “health care organizations to take a strong position against such practices.”

Under the category of education, one LebMASH board member gave a lecture about LGBT health to second-year medical students at the American University of Beirut in late 2012. This was the first time medical students receive such a lecture. The same author gave a Q&A Skype session about transgender health with 11th-grade students at the Dubai British School in February 2013.

Under research activities, LebMASH actively seeks funding to examine trauma in LGBT refugees in Lebanon. Currently, LebMASH is working on translating to Arabic a landmark study that was published by Shidlo and Schroeder in 2002 on reparative therapy.14 This activity falls under LebMASH’s commitment to making more scientific literature available in Arabic. LebMASH established the annual “Break the Silence” research award for students. The 2013 award went to a medical student who wrote an article on hymenoplasty. LebMASH has served as a consultant on a research project on perception of discrimination by LGBT people in the health-care system in Lebanon.

Under the category of advocacy, LebMASH worked closely with the Lebanese Psychiatric Society and the Lebanese Psychological Association to come out with historic position statements about homosexuality in May 2013.1516 These statements, the first of their kind in the Arab world, reaffirmed that homosexuality is not a disease and does not require any treatment. The statements also stressed the health risks of SOCE. These statements were widely discussed in national and international media.

Under the category of professional development, LebMASH sponsored a medical student in 2012 and another one in 2013 to travel to the United States to attend the annual conference of the Gay and Lesbian Medical Association: Health Professionals Advancing LGBT Equality.17 Attending such meetings brings international experience to students in Lebanon and diversifies their training and exposure.

In its first year of existence, LebMASH has faced several challenges. The first challenge was related to language. Arabic is the official language in Lebanon, which necessitates making all content available in or translated to Arabic to reach the general public. In addition, medical schools in Lebanon use either English or French language solely; therefore, it is important to provide all content in these two languages as well for a wider reach within the medical community. Using three languages is time-consuming and costly.

Second, LebMASH’s executive board has members who are based in Lebanon, the United States, and Canada. Even though this can be viewed as an asset especially when it comes to networking, resources, international reach, and experience, it presents a burden when board meetings or events need to be arranged. Finally, the political instability in the region makes people less concerned about health in general and sexual health in particular, and more concerned with issues of security.

Moving forward, LebMASH will continue to strengthen and expand its activities in the major areas outlined above: awareness, education, research, advocacy, and professional development. Also, LebMASH aspires to represent Lebanon at the international level on issues relating to LGBT and sexual health.

Conclusion

The past decade in Lebanon has witnessed some advances on the legal and social fronts for LGBT individuals; however, the health front has seen only minimal advances. LGBT individuals continue to face major barriers on multiple levels, and the gap in LGBT health remains very significant. LebMASH was established to address this gap, and during its first year of existence, it has proven to be a promising model for advancing LGBT health in difficult environments in which LGBT individuals lack civil protections.

References
  1. P Healy: Beirut, the Provincetown of the Middle East. The New York Times. July 29, 2009. Available athttp://travel.nytimes.com/2009/08/02/travel/02gaybeirut.html (last accessed on Nov. 11, 2013).
  2. N Saghiyeh, W Al-Farchich: Homosexual relations in the penal codes: General study regarding the laws in the Arab countries with a report on Lebanon and Tunisia. Helem. October 2009. Available at http://helem.net/node/53(last accessed on Nov. 11, 2013).
  3. A Awadalla: Lebanon—inflammatory TV show leads to arrests of gay men. The Global Voices. August 1, 2012. Available at http://globalvoicesonline.org/2012/08/01/lebanon-inflammatory-tv-show-leads-to-arrests-of-gay-men(last accessed on Nov. 11, 2013).
  4. J Ayoub: Lebanese police arrest four during gay club raid. The Global Voices. May 8, 2013. Available at http://globalvoicesonline.org/2013/05/08/lebanon-scandal-breaks-out-over-homophobic-raid-in-dekwaneh (last accessed on Nov. 11, 2013).
  5. Human Rights Watch: Lebanon—police torturing vulnerable people. June 26, 2013. Available atwww.hrw.org/news/2013/06/26/lebanon-police-torturing-vulnerable-people (last accessed on Nov. 11, 2013).
  6. F Elkak: Homophobia in clinical services in Lebanon, a physician survey. Helem. February 8, 2010. Available athttp://helem.net/sites/default/files/HELEMStudies_MroueKak_0.pdf (last accessed on Nov. 11, 2013).
  7. BBC World News: Outraged Lebanese demand end to anal exams on gay men. August 7, 2012. Available atwww.bbc.co.uk/news/world-middle-east-19166156 (last accessed on Nov. 11, 2013).
  8. Human Rights Watch: Lebanon: Stop “tests of shame.” August 10, 2012. Available atwww.hrw.org/news/2012/08/10/lebanon-stop-tests-shame (last accessed on Nov. 11, 2013).
  9. Russia Times: Test of shame! Lebanese protest against anal probe for suspected gays. August 11, 2012. Available at http://rt.com/news/homosexuality-anal-test-protest-lebanon-445 (last accessed on Nov. 11, 2013).
  10. Lebanese Medical Association for Sexual Health: Response to Dr. Khoury’s interview about homosexuality. June 24, 2013. Available at http://lebmash.wordpress.com/2013/06/24/pr2-en (last accessed on Nov. 11, 2013).
  11. J Tohme: MSM in Lebanon: A look at current HIV prevention and sexual health initiatives. The Global Forum on MSM & HIV. November 4, 2013. Available at http://msmgf-blog.blogspot.ca/2013/11/a-look-at-hiv-prevention-and-sexual.html (last accessed on Nov. 11, 2013).
  12. Marsa Sexual Health Center website. Available at http://marsa.me (last accessed on Nov. 11, 2013).
  13. Lebanese Medical Association for Sexual Health: Position statement on sexual orientation change efforts (SOCE). May 17, 2013. Available at http://lebmash.wordpress.com/2013/05/17/ps1-en (last accessed on Nov. 11, 2013).
  14. A Shidlo, M Schroeder: Changing sexual orientation: A consumers’ report. Prof Psychol Res Pract2002;33:249–259.
  15. Lebanese Medical Association for Sexual Health: Lebanese Psychiatric Society: Homosexuality is not a disease. July 12, 2013. Available at http://lebmash.wordpress.com/2013/07/12/lps-en (last accessed on Nov. 11, 2013).
  16. Lebanese Medical Association for Sexual Health. Third Lebanese Medical Group to denounce conversion therapy. July 18, 2013. Available at http://lebmash.wordpress.com/2013/07/18/lpa-en (last accessed on Nov. 11, 2013).
  17. Lebanese Medical Association for Sexual Health: LebMASH sponsors medical student’s trip to Denver USA. July 17, 2013. Available at http://lebmash.wordpress.com/2013/07/17/bts-en (retrieved on Nov. 11, 2013).

To cite this article:

Abdessamad HM, Fattal O. Lebanese Medical Association for Sexual Health: Advancing Lesbian, Gay, Bisexual, and Transgender Health in Lebanon. LGBT Health. 2014 Jan. ahead of print. doi:10.1089/lgbt.2013.0039.


I was invited to discuss birth control live on CKNW radio in Vancouver. Here is what I had to say:

– For my interview, start listening from 11:14 –

A recent study assessed compliance with the use of different types of birth control. Due to the importance of the study, I featured it on my blog (Which birth control will earn your loyalty). When Maureen McGrath, a nurse specialized in sexual health and hostess of the Sunday Night Sex Show on CKNW radio, received an email notification of my blog post (I am grateful that she follows my posts at habdessamad.com) she invited me to discuss the issue further live on her show on Jan. 26, 2014.

I would like to publicly thank Maureen McGrath for following my blog and for inviting me to her radio show. I commend the great work she does spreading awareness about topics that might still be considered taboo by many.

Dr. Hasan Abdessamad on CKNW radio - Vancouver

Dr. Hasan Abdessamad Vancouver CKNW Radio interviewDr. Hasan Abdessamad Vancouver Maureen McGrath CKNW interviewDr. Hasan Abdessamad Vancouver CKNW Radio interview


A study published by O’Neil-Callahan et al in Obstet Gynecol Nov. 2013 issue showed the following:

Compliance with long-acting reversible contraceptive (LARC) use at 2 years was 77% as compared to 41% of non-LARC use.

This means that if you are concerned about your daughter’s compliance with the use of her contraceptive you should bet on either an IUD (intrauterine device) or an implant.

So apparently the levonorgestrel intrauterine system (commercially available as Mirena) has a continuation rate of 79% at 2 years. This is almost similar to the copper IUD at 77%.

Rates were 43% for oral contraceptive pills, 41% for vaginal ring, 40% for the patch (commercially available as OrthoEvra) and 38% for the depot medroxyprogesterone acetate (commercially available as DepotProvera).

It is clear that if you place a patient on LARC they are more likely to still be on that contraceptive 2 years later which could suggest higher satisfaction levels but it could also be related to having to plan removal. In both cases the patient is protected from undesired pregnancy.