This is Who We Are: Building Community for HIV Prevention with Young Gay and Bisexual Men in Beirut, Lebanon

Abstract

Young gay men in Beirut are at significantly elevated risk of HIV infection compared to the general Lebanese population. Despite nascent HIV prevention efforts in the region, there is a need for effective community-level HIV prevention interventions tailored for young gay men. This qualitative study examined internal dynamics of Beirut’s gay community as a basis for developing community-level interventions. We trained peer ethnographers to collect field notes on conversations between young gay men in public spaces in Beirut, and conducted follow-up focus groups with young gay men. Analyses revealed three major themes (1) the need for safe spaces in which to socialise, (2) the importance of being able to locate and connect with other young gay men, and (3) ambivalence regarding a gay community that was supportive in some ways but also fragmented and often judgemental. Study findings also confirm the existence of external threats to community such as stigma, cultural, and familial norms regarding heterosexuality, and criminalisation of refugee status. Understanding such community dynamics and environmental context is central to designing effective community-based HIV prevention programmes.

Introduction

The HIV epidemic in Beirut remains primarily concentrated within certain subpopulations (Mahfoud et al. 2010), and there is growing concern that young gay men are at increased risk of infection. In a recent study of sexual risk within a sample consisting predominantly of young gay men from Beirut (mean age 26.2 years), 64% of respondents reported recent unprotected anal intercourse (Wagner et al. 2014). A review of HIV research with gay men in the Middle East and North Africa region revealed HIV rates as high as 28% in some subgroups of gay men (Mumtaz et al. 2011), with a rate of 3.6% reported among gay men in Lebanon (Mahfoud et al. 2010), which is significantly higher than the general Lebanese population (<0.1%) (UNAIDS 2015).

Newer methods of connecting with other men for sex and dating, such as smartphone apps, have become increasingly popular. This trend may increase vulnerability to HIV throughout Beirut’s gay community, as US-based research shows that unprotected anal intercourse between men is more frequent with sexual partners met online (Rosser et al. 2009). While sexual health services are available in Beirut and other areas of the Middle East and North Africa. There is presently no comprehensive HIV prevention programming designed for young gay men in Beirut or elsewhere in the region, in spite of growing concern about HIV risk in this population.

Our theoretical framework is informed by work that demonstrates a link between gay community mobilisation HIV prevention work (Altman 1994), arguing that meaningful involvement of community members is a necessary element in the development of effective responses to the HIV pandemic amongst gay men. Such community-level interventions have been effective in promoting safer sex behaviours among young gay men (Kegeles, Hays and Coates 1996; Kelly et al. 1997), in part by diffusing sexual health norms. Social networks and peer norms are important factors in HIV risk behaviours among young gay men in Beirut (Wagner et al. 2015), and can be used as part of community-level interventions. Yet, implementing interventions depends on having a better understanding of how the target community functions. Studies of young gay men in other regions have found that availability of safe spaces, relative visibility of young gay men, and community cohesion and support may be important factors to address (Hays, Rebchook and Kegeles 2003; Mutchler 2000). However, very little research has examined community dynamics that may be key to implementing community level HIV prevention interventions with young gay men in Beirut.

In recent decades, the introduction of a number of socially progressive institutions, such as the first gay rights organisation in the Arab world and a number of gay-friendly venues (e.g., bars, cafes) have contributed to Beirut’s burgeoning reputation as the gay capital of the Arab world (McCormick 2011). However, young gay men in Beirut also face a variety of obstacles to forging community ties. Throughout Lebanon, homosexuality remains widely stigmatised (Nasr and Zeidan 2015). A qualitative study with 31 Lebanese gay men found that most of them experienced stigma within social relationships (Wagner et al 2013). Current laws prohibit sex between men and, although these laws are rarely enforced, police harassment is common.

The prominent role of family in Lebanese culture presents unique challenges for many of these young men. Given that Lebanese adults traditionally live with their families until marriage, fear of being rejected or disowned by family can make the decision to disclose one’s sexual orientation particularly complicated and stressful (Wagner et al. 2013). In addition, regional conflicts have greatly increased the population of Syrian and Iraqi refugees in Lebanon, who may be subject to stigma and discrimination based on both sexual orientation and refugee status (Tohme et al. 2016). Internalising stigma can also contribute to guilt and distress among young gay men in Beirut (Wagner et al. 2013).

While a small body of literature has examined the external pressures confronting young gay men in Beirut, less has examined dynamics within the community itself. As recently as 2006, McCormick noted considerable scepticism among gay men in Beirut about whether the existing venues and activities constituted a community at all (McCormick 2006). Yet current research points to an incipient sense of gay community (Wagner et al. 2015), and McCormick (2011) recently noted the emergence of sub-communities. Our aim is to better understand issues such as these in order to support culturally-congruent community-based HIV prevention in Beirut, and our overarching research question is: What key dynamics influence the process of building and sustaining a community of gay and bisexual men in Beirut?

Methods

We conducted peer ethnography and focus groups to gain an insiders’ perspective on how young gay men in Beirut talk with peers about sexual health issues, gay and bisexual community engagement, and ideas for community-based HIV prevention programmes. Peer ethnographers were able to access to community spaces and conversations that would take much longer for non-peers to obtain, while the subsequent focus groups enabled us to deepen our knowledge of themes identified in the peer ethnography. The study protocol was approved by the RAND Corporation Human Subjects Protection Committee and the Institutional Review Board at the Lebanese American University.

Peer ethnography

Peer ethnography is a method of collecting observations of every day social interactions from the perspective of individuals who are similar to target participants (Watkins and Swidler 2009). Ten young gay men or friends of young gay men were selected and trained to collect field notes on communication they observed in their daily lives (Mutchler et al. 2013). We recruited peer ethnographers through the study’s community advisory board, local organisations, and university LGBT groups. We selected individuals who socialise frequently with young gay men ages 18–29, and trained them to collect field notes using methods of participant observation (Atkinson and Hammersley 1994). The ethnographers were instructed to document any public conversations they engaged in or overheard between young gay men in Beirut that were related to sexual health or experiences with the local gay and bisexual community.

Between August 2015 and January 2016, ethnographers submitted a total of 112 pages of field notes. They described their observations in detail, including the date, setting, content of the discussion, and—in a separate section—their subjective opinions regarding what they observed. To ensure observation of a wide spectrum of the community, ethnographers were instructed to write notes on at least 10 different young gay men in at least 3 unique settings (e.g., bars, coffee shops, university). Ethnographers were paid $20 per page of field notes, which were submitted via a secure online link. Nine ethnographers wrote field notes in English, while one non-English speaking ethnographer dictated his notes in Arabic to the bilingual study coordinator, who translated them to English.

All peer ethnographers were recruited in Beirut by our community working group and staff members. They had to have young gay male friends (with whom they talked about sexual health issues) in order to be selected as a peer ethnographer. The senior, second, and first authors conducted a training with peers to stress the importance of IRB approved protocol regarding confidentiality and safety. Peers were asked only to take notes on every day interactions that they were already engaged in, thus minimising additional risk to the peers. No peers revealed their roles to study participants.

Focus groups

In February and March of 2016 we conducted five focus groups (5–7 men each) with young gay men in Beirut. Two groups were conducted with men age 18–24, and two were conducted with men age 25–29. Within each age category one group was conducted in Arabic and one in English. A fifth focus group was conducted in Arabic with refugee young gay men from Syria and Iraq, ages 18–29. To be eligible, focus group participants had to identify as male, have had sex with men or attraction to men, and reside in Lebanon. Participants were recruited through word of mouth and outreach to community organisations through convenience sampling. Sampling numbers were predetermined based on the goal of reaching saturation (Krueger and Casey 2015) and previous experience conducting research with similar populations (e.g., George et al. 2012; Tohme et al. 2016; Wagner et al. 2013, 2014).

The focus groups lasted 90 minutes, and each participant was paid $30. Discussion guide questions were developed in collaboration with our community advisory board based on preliminary themes observed in the field notes. Questions included: What is life like in Beirut for young gay/bisexual men? What are the different subgroups of young gay men in Beirut? How are young gay men dealing with the threat of HIV? How do you feel about discussing and promoting safer sex with your peers? Two of the Lebanese authors conducted the focus groups. The first author and the senior author attended the first two focus groups to enhance the training of the local study staff.

Analysis

Data were analysed using a thematic analysis approach (Braun and Clarke 2006). All data were first anonymised (names replaced by pseudonyms) and entered into an analytic database (Dedoose). Team members from Lebanon and the USA read all field notes and group transcripts to identify preliminary themes, composing analytical memos. The research team developed a working codebook that included both emerging themes and themes relevant to existing theoretical frameworks and our own preliminary work. Two team members then manually coded the data. We established inter-rater reliability for coding by using rates of agreement between coders, with 80% as a criterion for reliability. All authors discussed the notes in weekly meetings and wrote analytical memos based on reviewing field notes as they were turned in. We discussed these memos and generated themes. We then developed definitions for the themes. Ethnographers were trained to keep two separate sections in their notes: observations in the field and personal reflections on the notes. As we reviewed field notes, therefore, we also reviewed and discussed the reflections of all of the peers.

During the next phase, axial coding, the whole team systematically reviewed data coded for each theme, noting key subthemes. Significant themes and subthemes were then summarised and shared with our community advisory board for feedback on relevance and accuracy. We asked for feedback on each theme and sub-theme, and engaged in interactive discussion with community members in Beirut. We then incorporated that feedback into our analysis as a validity-enhancing measure. Authors included Lebanese and non-Lebanese members from a variety of disciplines including sociology, clinical psychology, social psychology, and public health. This strategy of investigator and community member triangulation (Denzin and Lincoln 2000) facilitates analytical cooperation and exchange. We prioritised team consensus over individual interpretations of the data, reaching unanimous agreement on all major themes.

Findings

Results revealed three major themes related to community dynamics among young gay men in Beirut. The first was the critical importance of safe spaces. This was connected with concerns about the potential dangers of being openly gay or connecting with other young gay men. Many described the benefits they felt could accrue from creating more safe spaces, such as a sense of community empowerment, bonding, and belonging. The second theme focused on men’s efforts to locate, identify, and connect with other gay men, and the complicated calculus involved in decisions about self-disclosure. Participants depicted a community in which young gay men are increasingly visible, but where large subsets of men remain closeted even to other sexual minorities. The third theme addressed how the gay community was fragmented into subgroups, and how this fragmentation could reduce access to support. Participants described subgroups that were defined by physical appearance, income level, style, or other characteristics, and expressed concern about how judgmental attitudes and intergroup stigma divided them from each other. Many also noted the importance of support from other gay and bisexual men, and proposed numerous community activities geared to fostering bonds between members of different subgroups.

The Importance of Safe Spaces

One of the themes participants emphasised most was the importance access to safe spaces where gay and bisexual men could socialise without fear of being scrutinised or targeted by homophobic people or institutions. The settings they described were diverse, including cafés, bars, nightclubs, non-government organisations (NGOs), and homes. Yet these same spaces were also characterised by numerous limitations, such as social exclusivity and concerns about safety. There was also a sense that in non-gay-identified public spaces, overtly gay behaviour—such as holding hands with a person of the same gender—meant risking assault or legal persecution. Gay and bisexual refugees were particularly limited in their access to safe spaces, which impaired their ability to connect with each other in groups. Nearly all agreed that increasing access to safe and supportive settings was crucial to building a stronger community and a sense of freedom.

Diverse settings and activities

Field notes and focus groups depicted gay and bisexual men interacting in a diverse array of settings such as nightclubs, bars, cafés, and restaurants. One participant noted that in more cosmopolitan neighbourhoods some of these venues are known to be gay-friendly. For example, one bar was described as being ‘always packed’ on its well-known weekly ‘gay nights.’ Private residences were also mentioned often, particularly among more affluent individuals. Field notes portrayed gay and bisexual men engaging in a wide array of activities in these settings. For example, an ethnographer shared how one day each week was reserved as ‘series night’ during which he and his friends would gather to watch favourite shows, such as I Am Cait, a U.S. reality television programme about transgender celebrity figure Caitlyn Jenner. In some settings, gay men engaged each other in a form of playful banter and humorous insults known as shakher:

This week, I had a gathering with some friends for someone’s birthday. We were seven guys sitting in a home in Beirut. The gathering was full of laughs and the guys were mocking others or as we say in Arabic, ‘shakher,’ which is a creative art where you feminize gay guys in a funny way. (George – Field Note 2)

Limitations on connecting in public and private spaces

While notes portrayed a vibrant gay community, they also revealed limitations in access to safe public settings. According to one, ‘things are changing now, as you have more people who are open-minded, but overall it is still not easy to be a gay man in this society.’ The threat of persecution due to gathering as a group was seen as a potential deterrent to connecting with others in public spaces. Several participants described overt discrimination in public settings, including verbal ‘gay bashing’ and threats. One added that while he was ‘comfortable being gay,’ the reality was that ‘you cannot live freely with your sexuality [in Beirut]’ and displays of affection, such as holding hands or kissing, were risky in public spaces. Another highlighted the potential for danger:

We are not accepted as we are. They see us as sluts and do not respect us as humans… A straight person can do whatever they want, but a gay person cannot. If you want to kiss someone you have to be hidden, for fear of death. If you are lucky you will go to hospital, but you won’t be dead. (Focus Group 2 – Age 25–29)

Several participants also noted the limitations arising from how few unmarried men in Beirut have their own home. One estimated that ‘75% if not more of Lebanese gay guys don’t have their own place, as it is cultural to live with our family until we are married,’ noting that he had met men for rendezvous in dangerous settings, such as deserted buildings. Another expressed frustration that it was impossible to invite people to his home because his conservative flat-mate did not support his relationships with other gay men. Alternative meeting spaces included hotels, chalets, and hammams (traditional bathhouses)—each of which involved certain security risks and limitations.

Vulnerability of gay and bisexual refugees

The oppression described by refugees from Syria and Iraq involved even greater scrutiny and less access to supportive spaces. Many described concerns about being targeted by police, both as sexual minorities and as refugees. One young refugee explained, ‘As a Syrian man, if I encounter a police checkpoint and if the officer does not approve of how I look, or the way I’m dressed, or the way I speak, he could grab my phone and start going through it.’ This could lead to further harassment if the phone contained smartphone apps popular among gay men in Beirut, such as Grindr or Scruff. Even carrying condoms could be unsafe for refugees, due to assumptions that only people engaged in illicit sexual activities would possess them. One refugee said, “If we carry condoms…. they tell us, ‘What are you doing here? Are you spreading your filth?” The threat of condom possession as an excuse to harass refugees causes a fear of carrying condoms among some young gay men in Beirut, thus diminishing HIV prevention efforts. These dangers also prevented many from connecting with other gay men in public settings:

There are groups [of gay men]; you don’t see them being friends. It’s rare… Everyone would be watching them if they were in groups. Let’s say 6 people were together; someone might infiltrate the group and give information to the state. They’ll arrest them and humiliate them. That happened a while back. A whole group was taken from their homes. So that’s why they don’t gather in groups anymore. (Focus Group 3 – Refugees, Age 18–29)

Many refugees adopted self-protective measures, such as not carrying anything that might reveal their sexual minority status. This included not downloading smartphone apps that have become an increasingly important means for gay men in Beirut to identify and connect with each other. Tragic incidents became lessons in hyper-vigilance:

I have a friend who is LGBT who was arrested at a checkpoint. His papers are legal, but he is Syrian. The police officer took his phone, and he has a ladyboy friend, so the officer started telling him ‘You’re a faggot. You’re scum.’ They started beating him under the bridge. So, he complained to the United Nations. He still has marks now. He became a lesson to us; we can’t walk the streets anymore. We deleted everything off of our phones. It’s very difficult. (Focus Group 3 – Refugees, Age 18–29)

In spite of these obstacles, gay refugees found ways of connecting with each other. As one described his life, ‘I am Syrian. I have lived in peace in Beirut since 3 years ago. I have a partner since 3 years ago, and I am happy now. I am gay, and I am proud.’ Some also said night-time afforded a modicum of security, a temporal ‘space’ in which to be themselves:

The night is ours and the day is theirs. They have all day to exist and we come out at night. We can’t do anything in the daytime. If they see us walking down the street or something they criticise us, they harass us verbally. We hear a lot of prejudice, slang, and all sorts of bad mouthing. But this is our life, and this is something we love. This is who we are. (Focus Group 3 – Refugees, Age 18–29)

A desire for safer and affirming spaces

Focus group participants reflected on what type of spaces are needed to strengthen the community. Some spoke of wanting an affordable community centre. Ideally, they said, attendees would be welcome to stay for as long as they’d like, enabling them to get to know each other better and develop romantic relationships: ‘It should be a space where two guys can be alone and express themselves or get intimate without getting caught…and where they don’t have to stay on their toes.’ Such spaces were also seen as useful in overcoming community divisions and addressing sub-community stereotypes because ‘at present we lack those places where you go and actually see there is a person behind the person.’ As another commented poignantly,

We need a space where we could meet freely. Not just pubs, nightclubs, or cafes... a space where you could go grab a book, read, meet another person, have a conversation, share stuff. This place…could help us bond with each other on a level we didn’t even know we could bond. (Focus Group 1 – Age 18–24)

A community space was viewed as a means of fostering self-acceptance. One participant remarked that ‘even the fact that these places exist’ could convey to ‘closeted’ men that ‘if they want to come out they can go to a place where they can feel comfortable—a safe place.’ A safe space was also seen as potentially allowing gay men to experience a sense of belonging, a quality described as in short supply in other spaces in Beirut:

I think it’s important to create a place where people can come and be with people who understand them and feel accepted… Growing up it was hard to find other gay men, or to feel belonging to a place, especially on social media. (Focus Group 2 – Age 25–29)

Finding Each Other: Balancing Safety with Visibility

Another theme was that gay men are becoming increasingly visible to each other—better able to locate and identify each other, not only by visiting gay-identified venues, or through friends, but also online. This was juxtaposed with the limited visibility of ‘discreet’ men, who were described as existing on the margins of the gay community, not disclosing their sexual orientation even to other sexual minorities, in order to avoid stigmatisation. Finding and connecting with other gay men increasingly occurs through social media or smartphone apps that identify gay men in the vicinity of the user. Many liked how these apps offered more efficient connections, but also felt frustrated that they emphasised superficial attributes and sexual encounters over deeper personal connections. As found in a qualitative study of Turkish gay men, prevalent hegemonic norms for masculinity may prevent gay men from accepting who they are, leading to internalised stigma (Eslen-Ziya and Koc 2016). Increasing visibility of gay men and exposure to positive gay identification may help young gay men in Beirut develop their own positive sense of gay identity (Koc and Vignoles 2016).

Gradually increasing visibility

Many participants noted an overall increase in public openness over the past several years among a certain portion of gay men in Beirut, where increasing numbers of men ‘are more confident to come out as gay.’:

A few years ago, there is no way I would come out. But now it’s happening more often… It helps people ease into the thought of coming out, even if they don’t intend it but they see that there are things happening. When they see it’s out there they think, ‘maybe it’s time for me to come out.’ (Focus Group 2 – Age 25–29)

Many attributed this increased openness to a decline in overt homophobia and state persecution. Others highlighted evolving media representations of gay men and transgender women on television. Several also cited advocacy efforts of NGOs and grassroots movements that have fought for increased tolerance and legal protections, enabling sexual minorities to feel that ‘it’s not only me; there is a community that’s kind of protecting me and others.’ Another described the situation this way:

[Being gay in Beirut] is not really a taboo anymore. It’s a little more open than before, when it was really hidden. We have several NGOs talking about it, and some are openly advocating for gay rights—working along with the gay community. (Focus Group 2 – Age 25–29)

Importantly, this sense of increasing openness was seen as limited to certain areas of Beirut, a city where ‘if you know how to find the places where you can be free, there are a lot of gay friendly places.’ However, other areas within Beirut were seen as more dangerous to be openly gay, as were most regions of Lebanon outside Beirut. Furthermore, participants also described a subset of gay men as ‘discreet,’ meaning that in addition to not disclosing to family, they had not come out to other members of the local LGBT community. Some of these men would be open among a very limited circle of trusted friends, forming small islands of social support. These men had little interaction with other gay men out of concerns about exposure or persecution. Discreet gay men were described as being less aware of sexual health issues, with limited access to information about STIs, condom use, or services.

Finding each other through smartphone apps

Many participants noted how the process of connecting with other gay men increasingly occurs through smartphone apps, which have become so popular that some felt they have superseded efforts to meet in-person. As one put it, ‘If you go to a bar, everyone is on their apps, and there is no communication. The apps have set boundaries, and gay guys are not talking without the apps.’

Participants often held both positive and negative views of these apps. Those who held mainly positive views often pointed to the usefulness of apps for meeting other gay and bisexual men, expressing their sexual desires, or facilitating sexual experiences that would otherwise be difficult to arrange in Beirut. One explained that informing others ‘what you’re into’ is much easier now since ‘you have Grindr doing all the work for you.’ Some described apps as a way for them to fulfil their desires without the risk of attending public gay-identified venues or events:

If there weren’t apps how would people meet? Ten years ago, we used to meet other gay men in cruising areas or wait for someone to smile or wink at us to realise that they are gay. It would take 3 or 4 months to meet someone! (Focus Group 3 – Refugees, Age 18–29)

However, many men also expressed frustration about apps because they seemed to prioritise casual sexual encounters over more intimate connections. Some also observed that dating apps tended to emphasise physical characteristics and thus make individuals vulnerable to stereotyping based on superficial attributes, such as ethnicity or body type.

The Struggle for Support: Community Divisions, Barriers and Facilitators to Connecting

Another major theme was that the local gay and bisexual community was perceived as fragmented, with various sub-communities (such as ‘bears,’ ‘muscled,’ or ‘effeminate men’) divided by stigma and judgementalism, limiting access to social support. While sub-communities could provide a sense of camaraderie to those within them, most participants associated them with antagonism between gay men. Supportiveness within the community was seen as gradually increasing, particularly for diverse sexual orientations or gender identities. Yet participants voiced a clear desire for a more supportive community experience with more unity overall.

Community subdivisions

Participants frequently referred to various sub-communities, describing them as ‘common knowledge’ among gay men living in Beirut. Many noted divisions across these categories, such as the ‘party community’ and the ‘theatre and arts community’. However, age, lifestyle, and body type were mentioned most often as the basis for these distinctions:

We started drinking, and the topic of dating came up and soon Jalil was talking about the different ‘types’ of guys in the gay community. He mentioned cubs (who according to him are guys in their early to mid-twenties that are a bit big), bears (those who have the same build as a cub but are older), silver foxes (older, good looking men in their mid-forties and above), and twinks (slender boys between 18 and 23 with little body hair). (Charlotte – Field Note 6)

Perceived antagonism between sub-communities

Participants frequently noted antipathy between sub-communities. For example, one mentioned that members of the ‘muscle bear’ community sometimes disparaged members of the ‘bear’ community because of their ostensibly smaller physiques. Others indicated that judgmentalism and exclusivity was frequently directed towards effeminate guys. One suggested that this ‘scattering of groups’ was due to ‘fear of others’ while another proposed that men from different sub-communities were ‘ashamed of each other,’ particularly of those perceived as more feminine. While gay men in Beirut share important commonalities, there is difficulty in being fully supportive of each other across differences:

We are like a book under the name of Gay, in that we are attached from the side and we are like layers… but in a book all the layers work together in order to have a complete story. So, we are also not like a book; we are like a high school. These communities are making fun of each other. (Focus Group 1 – Age 18–24)

Gossip, stigma, and judgementalism as barriers to connecting

Participants also described gossip as a barrier to support within the community. Given the small size of the community, sensitive and possibly inaccurate information could quickly disseminate and potentially cause harm to an individual’s reputation among peers. Fear of such outcomes could result in some men becoming more selective about what they disclose with friends. For example, having multiple sex partners was perceived by some as shameful and stereotypically associated with having STIs. Thus, gossip about this could be socially damaging:

One night, Rob and I were sitting having a drink in one of our favourite bars, when a friend of ours walks in and greets us and turns to Rob with a malicious smile and attitude and says ‘ ’ which would literally translate into ‘What’s up, slut?’ I could tell that Rob’s buttons were pushed; what Adib said was very provocative to him. Rob defensively retaliated and said, ‘ basically asking him what he’s trying to get at. Adib merely mentioned how Rob has been giving himself a reputation, and how the word on the street is that people are now worried about sleeping with him because they claim that he’s sleeping around so much that he must have caught an STD. (Liz – Field Note 8)

HIV and STI stigma were also mentioned often, and dating was described as more difficult for men living with HIV because their status ‘instantly frightens people that want to go out with them.’ Expectations of gossip could cause individuals to be cautious about disclosing their HIV or STI status, potentially limiting their access to support around sexual health issues. As one described it, ‘Telling people you have an STI might socially isolate you, as very few people are educated enough on the topic and are accepting of those with STIs.’ Some felt the community could work on decreasing stigma to increase access to support:

I had an experience with an STD a while ago and I got treated for it. I received support from my friend, but I felt that I could not talk to anyone else, because there is a lot of stigma. People would ask, ‘Why did this happen to you? Why weren’t you careful?’ So, I think we need to work on the stigma regarding STDs and HIV. (Focus Group 5 – Age 18–24)

Several field notes also revealed the judgmental tone that conversations about sexual health could take, where sexual risk behaviour could be taken as indicative of a problem in one’s character. Thus, disclosing that one engages in unprotected sex or has multiple partners could also lead to moralistic responses:

Curtis started talking about his sexual life, describing how risky he can be and how far he can go with random people that he doesn’t know. Michael asked him in a direct way, ‘Why you do this? Are you a slut?’ (Kareem – Field Note 1)

As with HIV/STI stigma, such responses seemed to reduce individuals’ willingness to disclose their risk behaviour to friends. This was noted by some as another area where the community could learn to be more supportive:

We can learn on how to talk about [sexual risk] in ways that are supportive and accurate. Most of the time we react in a way that is not suitable, such as [snaps fingers] ‘Why did you do this? It’s wrong!’ We shouldn’t talk like that. The way we talk about these issues is more important than what we are talking about. (Focus Group 4 – Age 24–29)

Growing support for sexual and gender diversity

While exclusivity and stigma were recurring themes, participants also noted increasing acceptance of diverse gender identities, sexual desires, orientations, and relationship styles—such as polyamorous and open relationships. For example, one field note depicted an individual coming out to friends for the first time about being transgender and receiving a supportive response:

Boris said, “One day I will become a woman, and I am worried about not having stuff in common with my friends like now.” …Around 5 guys took turns in giving Boris hugs and tell him that they were proud of him for having the courage to tell everyone and that they will always love him. (James – Field Note 2)

Valuing support from other gay and bisexual men

Despite frequently expressing criticism of the local community, participants also voiced appreciation of connections with other gay and bisexual men. Being among gay men, one individual noted, allowed him to feel more at ease. Another felt friendships with gay men were important for social support, particularly when navigating sexual health issues:

Let’s say you have a burning sensation when you pee. You can ask your [gay] friend. You can’t ask someone who is straight or go to [NGO]. They will judge you and say you are a bad person, and that it is your fault for not using a condom, or because you have a lot of sex. But I can share it with a friend because he can relate and understand. (Focus Group 3 – Refugees, Age 18–29)

Participants also shared ideas for fostering a more supportive community through new activities, such as free social events, group discussions, and forums related to sexual health, the arts, and other topics. A few hoped that such programmes could help integrate the community:

[New community activities] could help fight off the sub-communities inside the community, for example, the bear community and the hunk community. We can bring all these together. Instead of each one being separate, we can bring them all in one location and help them bond. (Focus Group 1 – Age 18–24)

Discussion

The purpose of our study was to explore how community dynamics affect young gay men in Beirut, Lebanon. Our findings reveal both the progress and challenges that the community of young gay men in Beirut face in its potential development toward a supportive community that can effectively promote health and well-being. Through analyses of multiple forms of qualitative data on this emerging community, the present study sheds light on three factors that participants viewed as important for the emergence of a sense of community in Beirut: (1) safe spaces in which to congregate in small or large groups, (2) the ability to find each other (mutual visibility), and (3) expectations of supportiveness from other community members. The findings also confirm the existence of external threats to community, such as stigma, cultural and familial norms, and criminalisation of refugee status. Understanding such community dynamics and environmental context are central to designing effective community-based HIV prevention programmes.

One major theme we found was the importance of safe spaces for the development of community level health promotion activities. The data suggested that young gay men in Beirut are able to gather in an increasing number of venues such as clubs, bars, coffee shops and some non-governmental organisations, which is significant given the key role of safe spaces in gay communities described in other national contexts (Rowe and Dowsett 2008). However, many participants felt that meeting in most public spaces was still dangerous. Experiences of ‘gay-bashing’ are well known and prohibit many young gay men from feeling safe about expressing themselves in public. Gay refugees are vulnerable since they can be searched, harassed and possibly arrested. Gay refugees are particularly at risk since police may search their phones for evidence of being gay or question why they are carrying condoms.

Despite these challenges, there is a growing desire for safer and more gay affirming spaces to meet other young gay men in Beirut. Such spaces are necessary for building and strengthening community ties. Several organisations in Beirut do currently provide sexual health information, condoms, and free HIV testing, but do not target gay men publicly. This information is largely advertised via word of mouth, referrals from agencies and physicians, and public campaigns and websites. If materials specifically indicate that they are for gay men, it can be risky for men to carry them around since they could be “outed” by security personnel. Such materials may be provided within safe spaces for young gay men in Beirut. The provision of safe and affirming spaces may help to foster communities’ ties and social norms regarding condom use and other health behaviours (Rowe and Dowsett 2008; Altman 1994).

In addition to safe spaces, many young gay men talked about complexity and challenges of locating and connecting with other young gay men. While there are increasing avenues for meeting, especially via smartphone apps, many young gay men stated that challenges persist in terms of overall visibility of gay communities in Beirut. Such opportunities for intimacy and dating are curtailed by societal stigma and the lack of visibility for many gay men in Beirut. The continuing need to hide their sexual identity means that many young gay men have limited access to social support and positive role models needed for sexual identity formation. Since earlier work has found connections between stages of sexual development and disclosure and HIV prevention behaviours, such as condom use and HIV testing (Wagner et al. 2013), these community dynamics clearly impinge on efforts to promote sexual health and prevent further HIV infections among young gay men in Beirut.

Another major study finding is the importance of addressing access to social support as a core element of gay community development in Beirut. The data speak to numerous community divisions amongst different sub-communities of gay men, and frustrations about gossip and stigma. Similar divisions have been observed in other gay communities (Peacock et al. 2001). In addition to obstructing support, judgementalism between young gay men can shut down important conversations about sexual health or social support between friends (McDavitt and Mutchler 2014). Yet, many young gay men yearn for a more supportive community, and the notion of gay community itself was, as Rowe and Dowsett (2008) found, a ‘potent force’ (339), that many young gay men in Beirut are negotiating with, both as object of frustration and source of strength. Fortunately, there are signs of increasing support for sexual and gender diversity, and hope for a more supportive community among many young gay men. However, the internal challenges may need to be addressed in order to continue building stronger community cohesion, and thus, healthier ties between young gay men in Beirut.

There are some important limitations to this study. First, data for the focus group portion were self-reported and reflect any potential biases of the participants. For example, although difficult to assess, it is possible that the sense of disillusionment felt regarding the gay community may result in part from internalised homophobia on the part of the participants, prompting negative views not only of themselves but their gay and bisexual peers. Another limitation is that peer ethnographers and focus group participants were not selected at random, limiting the generalisability of the findings.

Findings from this study revealed environmental threats related to security, stigma and discrimination, as well as dynamics at the community level and within young gay men themselves. They appear to reflect an ongoing process of community development and increasing levels of openness, as well as fragmentation and struggles with sexual identity development (self-acceptance and disclosure of sexual identity). These factors and processes may influence HIV prevention behaviours (Wagner et al. 2013, 2015). There is a need for HIV prevention interventions that can target these interconnected individual, social, community, and environmental factors affecting young gay men in Beirut. One example is Mpowerment, a community-level intervention that draws on diverse social networks, including sub-communities, to diffuse safer sex and HIV testing norms among young gay men while building community (Kegeles, Hays and Coates 1996; Hays, Rebchook and Kegeles 2003). However, it will be crucial that programmes such as these in Beirut emphasise protecting confidentiality and security while promoting social ties and safer sex behaviours. Mpowerment may be able to capitalise on the existing interest in building community that many participants expressed in order to foster sexual health behaviours and HIV testing, while also helping young gay and bisexual men connect and find support in a challenging environment.