Middle Eastern LGBTQs Underrepresented in Health Research — And That’s a Problem | chelseanow.com

Middle Eastern LGBTQs Underrepresented in Health Research — And That’s a Problem

BY PAUL A. BROWN, MA, MPH (College of Global Public Health, NYU) | This year, Pride Month took on a distinctly activist tone in response to the Trump administration’s flagrant disregard for the rights of women, people of color, immigrants, and LGBTQ folks. While the demand for a more intersectional approach to LGBTQ activism is heartening, as an Arab American I can’t help but feel that the voices LGBTQ people of Middle Eastern and North African (MENA) origin are not being heard at a time when anti-Arab, anti-refugee, and Islamophobic sentiment is at an all-time high.

“We are all equal,” reads the sign. Photo by Paul A. Brown.

As an LGBTQ health advocate, I am particularly concerned that these voices are excluded from conversations on sexual health policy and advocacy. In August of last year, I had the opportunity to conduct a study out of the Center for Health, Identity, Behavior and Prevention Studies (CHIBPS) examining discrimination and sexual risk among Arab men who have sex with men (MSM) living in the United States. The Shabaab study, as it was called, was my attempt to spark a dialogue around sexual health and HIV risk among LGBTQ people of MENA origin living in the United States. Although the sample was small, the results were intriguing: Half of participants had experienced some discrimination based on their ethnicity, and while no one reported positive or unknown HIV status, nearly 60 percent reported having tested positive for a sexually transmitted infection (STI), a risk factor for HIV.

Research has shown that a combination of factors, including systemic discrimination, lack of access to resources, racism and homophobia, have contributed to poor health outcomes such as depression, drug and alcohol use, and increased rates of HIV for Black and Latino LGBTQ people. At a time when LGBTQ people of MENA origin are facing similarly discriminatory circumstances, why is no one seeking to learn more about the health outcomes and potentially risky behaviors of this population? The fact of the matter is that we know next to nothing about the health outcomes of MENA populations living in this country, never mind those who are LGBTQ. It is high time public health researchers investigate this severely understudied population.

Researchers will face several challenges on this front. For starters, defining what it is to be “Middle Eastern” is not an easy feat. While many policies explicitly target American Muslims for surveillance, detention, and deportation, the racialization of Islam in this country has meant that many non-Muslim people from the Middle East, North Africa, and elsewhere have been targets of anti-Muslim policies as well as victims of xenophobic and racist assaults. The recent shooting death of Khalid Jabara by a racist neighbor in Tulsa, or the absurdly common targeting of Sikhs for enhanced airport screening, illustrates this point. Thus, studies focusing solely on Muslims would be to the exclusion of many from the region who may suffer the deleterious effects of social isolation stemming from various forms of discrimination.

Yet despite the Muslim/Middle Eastern equivocation, simply reporting research on “Middle Eastern/North African” LGBTQ people would dilute important distinctions in the myriad cultures, values, beliefs, and attitudes seen throughout the region — distinctions that influence risk behavior and health outcomes. In the Shabaab study, I did my best to narrowly define my population of interest: Arab MSM. Try as I might, I knew that the study’s eligibility criteria would still inevitably oversimplify the lived experiences of many people from a geographic region that extends from the Atlantic to the Indian Ocean. Paradoxically, my study would also exclude many from the region who likely share similar experiences of Islamophobia and xenophobic discrimination, including Berbers, Kurds, Armenians, Assyrians, Chaldeans, Turks, Persians, etc.

Second, reaching this population for study will be another hurdle for health researchers. For starters, finding even the simplest demographic or health data for this population is extremely difficult. Due in part to lobbying efforts by early Arab immigrants to the United States, people of Middle Eastern origin are counted as white by the decennial Census and most public use data from large scale surveys do not have an Arab, Middle Eastern, or North African ethnic category in their demographic questions.

Additionally, finding queer MENA folks to participate in studies on sexual behavior and HIV risk is even more challenging. This stems from two major issues. First, obtaining community leader buy-in, an otherwise useful way to reach marginalized communities, is difficult. While some prominent leaders, such as Palestinian-American activist Linda Sarsour, have broached the subject of LGBTQ rights, discussions around LGBTQ issues, sexual health and drug use are difficult to engage in for many MENA communities. Second, explicitly queer Middle Eastern and North African spaces are virtually non-existent save for a few major urban centers. Unless you live in New York or Los Angeles, chances are good that there is no Middle Eastern equivalent of Latin night at your local gay bar. These are often excellent spaces to recruit potential participants for LGBTQ research. A dearth of these spaces makes study recruitment a daunting task for health researchers.

Third, assumptions about sexual behavior and HIV risk (or lack thereof) among MENA populations, even LGBTQ ones, means funding opportunities for such research are few and far between. Perhaps because HIV prevalence in the MENA region remains low compared to other parts of the world (despite recent, alarming trends), health researchers in the US reason that MENA populations living here are similarly a “low-risk” population. This is an erroneous assumption and, simply put, we just don’t know whether it is true. The result of all this is a vicious cycle: With scant data from population surveys to point to, researchers have a difficult time making the case to fund even pilot data — and without pilot data, the case for larger studies is even more challenging.

While the challenge may appear to be insurmountable, I believe there are certain steps that can be taken to improve our understanding of the health outcomes of LGBTQ MENA communities living in the US. First, activists and community members should continue to push for, and encourage inclusion of, a MENA racial or ethnic category in population surveys. A campaign to include such a category on the Census has been going on for at least a decade (I worked on one such campaign in 2010). This effort should be extended to health outcomes surveys such as The Behavioral Risk Factor Surveillance System (BRFSS) and The National Health and Nutrition Examination Survey (NHANES).

Second, researchers should be mindful of how these communities are grouped together in study cohorts. Studies on LGBTQ Muslims should certainly be conducted, but lumping all Muslims together as a cohort may not be useful; American Muslims represent an extremely diverse range of nationalities, ethnicities, languages, creeds and ways of worship. One of the things that researchers of minority LGBTQ communities look at is rejection or isolation from one’s community because of sexual orientation or gender identity. To cast Islam as a single “community” and ascribe to it experiences of rejection among LGBTQ Muslims would mischaracterize the lived experiences of these communities and would play dangerously into stereotypes of an already maligned religion.

Finally, as a public health advocate, I understand that addressing community health does not just occur in the lab or the clinic. Social isolation is one of the major factors associated with poor mental health and risky behavior among LGBTQ folks. Thus, I’d like to leave a few thoughts with my LGBTQ brethren seeking to forge intersectional alliances against the growing tide of homophobia, transphobia, racism, Islamophobia, and anti-immigrant vitriol in this country:

Do not treat queer MENA folks as victims of their culture(s).

Do not assume they have forsaken their ethnic/national/religious/cultural identities for their chosen LGBTQ ones.

Do not assume that homophobia supersedes their struggles with racism, Islamophobia, imperialism, war or settler colonialism.

Good public health programs are data-driven, evidence-based, and community-led. We have a ways to go to fully realize and address the health needs of the LGBTQ MENA community. In a time when both science and protections for marginalized communities are under assault, we must fight to address these needs harder than ever before.

Contact the author at shabaab.study@gmail.com. For info on CHIBPS, visit steinhardt.nyu.edu/appsych/chibps.