Beirut: Difference between revisions

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'''OVERVIEW'''  

As the capital city of Lebanon, you will find a wide variety of health care resources in Lebanon. Contraceptives (birth control) are available in pharmacies without a prescription. Emergency contraception ("the morning after pill") can be purchased without a prescription at pharmacies, even though you may technically need a prescription. Note that ellaOne, the most effective EC on the market (as of 2016), is available in Beirut. You can get STI tests in Beirut and there are some confidential testing facilities. Be aware that some facilities test for only HIV, rather than a range of STIs. Furthermore, if you are applying for a work permit, you are required to take an HIV test and, if the results are positive, you will be deported. You can access HPV medication in Lebanon, but no national vaccination program is in place. There is currently no PrEP in the country. In 2014, maternity leave was extended from seven weeks to ten weeks. Finally, abortion is illegal in all circumstances, except for cases when a woman's life is endangered. While the law imposes harsh punishments upon those who seek out or perform abortions, the legal reality of the situation appears to be a bit more complex. There are many clandestine abortions performed in Beirut and, so long as no family members issue complaints, the government seems to look the other way. However, one should remain especially careful if pursuing this path, and may want to consider seeking out an abortion in countries where they are legally performed, such as [[Turkey]].

'''General Note:''' There are many types of contraceptives, also known as "birth control," including IUDs, oral contraceptives, patches, shots, and condoms, etc. If you would like to view a full list, click [https://www.plannedparenthood.org/learn/birth-control here].

In Lebanon, you can purchase hormonal birth control without a prescription. In 2007, it was estimated that 58% of Lebanese women use some form of contraception. In Beirut, it was estimated that 26% of women use oral contraceptives, 20% use IUDs, 24% use natural family planning (also known as the "fertility awareness method"), 16% use the withdrawal method and 15% use other methods.<ref>[http://www.lsfm.net/6th%20Annual%20Conference/Sunday/contraception.pdf Contraception: Lebanese Lebanese Society of Family Medicine Lebanese Society Society of Family Me]</ref>  

While Lebanon is liberal compared to many of its neighbors, sex education and premarital sex still remain taboo. In schools, sex education is often limited to basic biological information. Furthermore, there are reports of widespread misinformation surrounding contraception, including the false belief that birth control pills cause infertility. Many women shy away from sex education and family planning guidance, as they may be having premarital sex and feel embarrassed or ashamed.<ref>[http://www.dw.com/en/bound-by-taboos-lebanese-women-seek-abortions/a-17396085 Bound by taboos, Lebanese women seek abortions]</ref>

* For a list of contraceptive options available in Lebanon, click [http://contraceptive.ippf.org/search?search.searchtext=&search.component=&search.countrycode=LB here].

* If you're interested in hormonal birth control, you can purchase '''birth control pills''' at pharmacies. Some brands you can expect to find are Belara, Diane-35, Femoven, Gracial, Lo-Femenal, Marvelon, Microgynon, Microval, Neogynon, Nordiol, Ovral,  Microgynon-30, Nordette, Yasmin and Yaz.<ref>[http://contraceptive.ippf.org/search?search.searchtext=&search.component=&search.countrycode=LB IPFF - Lebanon].</ref>

* If you want a '''contraceptive shot/injectable''', you can find Depo-Provera or Noristerat in Lebanon.<ref>[http://contraceptive.ippf.org/search?search.searchtext=&search.component=&search.countrycode=LB IPFF - Lebanon].</ref>

'''Important Notes:''' Emergency contraception may prevent pregnancy for three days (72 hours) and sometimes five days (120 hours) after unprotected sex. Take EC '''as soon as possible''' after unprotected sex. If you don't have access to dedicated EC, oral contraceptives can be used as replacement EC, but remember the following: 1) Only some contraceptives work as EC 2) Different contraceptives require different dosages and time schedules to work as EC 3) You must only use the first 21 pills in 28-day packs and 4) They may be less effective than dedicated EC. For general information on emergency contraceptives, click [https://www.plannedparenthood.org/learn/morning-after-pill-emergency-contraception here] and [http://ec.princeton.edu/info/ecp.html here].

In Lebanon, you can purchase emergency contraception (the morning after pill) without a prescription at pharmacies. You may technically need a prescription to purchase emergency contraception (we're still waiting on confirmation of this), but it doesn't seem to be widely enforced.

'''Note:''' The longest-lasting EC is currently [http://www.ellaone.com/ ellaOne]. It lasts up to 5 days (120 hours) after unprotected sex, and it's available in Lebanon. Copper IUDs may also prevent pregnancy up to 5 days after unprotected sex. If none of these options are available, and it's been over 3 days since you had unprotected sex, you can still take EC, which may work up to 5 days. Note that EC pills are not 100% effective and should be taken as soon as possible.

Below, we have provided information about dedicated emergency contraception. If you cannot purchase emergency contraception, you may also use oral contraceptives as replacement emergency contraception, which we describe how to do below. Information provided by [http://ec.princeton.edu/ Princeton EC Website].

''Dedicated Products / Anti-Progestin

Take 1 pill within 120 hours after unprotected sex:''<ref>[http://ec.princeton.edu/worldwide/ Princeton EC Website]</ref>

* ellaOne

''Dedicated Products / Progestin Only

Take 1 pill within 120 hours after unprotected sex:''<ref>[http://ec.princeton.edu/worldwide/ Princeton EC Website]</ref>

* NorLevo 1.5mg  

''Oral Contraceptives used for EC / Progestin Only

Take 50 pills within 120 hours after unprotected sex:''<ref>[http://ec.princeton.edu/worldwide/ Princeton EC Website]</ref>

* Microval  

''Oral Contraceptives used for EC / Progestin-Estrogen Combined

Note: in 28-day packs, only the first 21 pills can be used

* Ovral

''Take 4 pills within 120 hours after unprotected sex and take 4 more pills 12 hours later:''<ref>[http://ec.princeton.edu/worldwide/ Princeton EC Website]</ref>

* Lo-Femenal

* Nordette

One local reported that she paid 75,000 LBP for ellaOne in a Beirut pharmacy. However, there are probably cheaper prices for other pills (not ellaOne) or potentially cheaper pharmacies.

'''Important Notes - Learn about PEP and PrEP:''' If you think that you've been recently exposed to HIV (i.e. within 72 hours), seek out PEP (Post-Exposure Prophylaxis). It's a month-long treatment to prevent HIV infection after exposure, and it may be available in your city. Take PEP as soon as possible. For more information, click [https://www.aids.gov/hiv-aids-basics/prevention/reduce-your-risk/post-exposure-prophylaxis/ here]. If you are at risk of HIV exposure, seek out PrEP (Pre-Exposure Prophylaxis). It's a daily oral pill that can prevent HIV infection before exposure. To learn more about PrEP, click [http://www.whatisprep.org/ here].

If you are traveling to Lebanon as a tourist, there are no travel restrictions related to HIV or STI status (i.e. no medical certificate or tests required). However, if you are applying for a work permit in Lebanon, you are required to submit paperwork proving that you are HIV negative (and potentially negative for other STIs as well). If you are found to be HIV+, you will be deported and the recruitment agency will cover the repatriation costs.<ref>[http://www.hivtravel.org/Default.aspx?PageId=143&CountryId=105 LEBANON - REGULATIONS ON ENTRY, STAY AND RESIDENCE FOR PLHIV]</ref>

While STI tests are available in Lebanon, they are reportedly not very common. There is a common misconception that people who have been abroad or participated in "hek-hek" (so-so) relations should get tested, but that not everyone should get tested. Furthermore, some men are reportedly too "macho" too get tested.

Regarding HPV, while Lebanese women are at risk, there seems to be limited HPV awareness. Furthermore, Lebanon has no national HPV vaccination program in place (as of 2016). Here's an [https://habdessamad.com/2010/10/23/hpv-in-lebanon/ article] about suboptimal HPV awareness in Lebanon.

* [http://www.marsa.me/ Marsa Sexual Health Center]: Free Voluntary Testing and Counseling (VCT) for the detection of HIV1/2, Hepatitis B and C using the rapid test. Medical consultations and management of Sexually Transmitted Infections (STIs) by a specialized Doctor.  General STI screening for a subsidized price. "The main objective of the Marsa Sexual Health Center is to provide social, psychological, and medical services in complete confidentiality to all youth, adults and sexually active individuals in Lebanon; regardless of their gender, age, religion, social status and sexual orientation." Address: Myrtom House building, 2nd floor, Near Hagazian University, Clemenceau, Tel.: +9611737647. Email: visitus@marsa.me.

* [http://www.aubmc.org/ American University of Beirut Medical Center]: They do blood work so should be able to give an HIV test, as well as potentially test for other STIs. Note that this is one of the top private hospitals in Beirut, so it will probably be more expensive. Address: Lebanon, Phone: +961 1 374 374

* [http://www.drismaelmaatouk.com/ Dr. Ismail Clinic]: Specializes in STIs. Not sure if he only does treatment or also does tests, but it's worth inquiring to see. Address: Hamra, Cairo Street (facing Costa Café), SGBL building (Masabki-Serhal), 2nd floor+961 1 755911, info@drismaelmaatouk.com

* [http://www.marsa.me/ Marsa Sexual Health Center]: Free Psychological counseling for People Living With HIV, Free social counseling and follow-up, Psychosexual counseling and couples therapy, Reiki relaxation sessions. Phone/Fax: +961 1 737647; +961 70 713384 Beirut, Hamra, Clemenceau, next to Haigazian University, Mexico Street, Myrtom House Building, 2nd Floor. Email: info@marsa.me.

* [http://helem.net Helem]: "In Helem's health initiatives, we adopt a rights-based approach that recognizes the particularities of HIV/AIDS, sexually transmitted illnesses (STIs) and sexual health relative to LGBTs. We are partnered with local NGOs in long term projects that aim to raise awareness on HIV/AIDS and STIs among LGBTs and to place the sexual health concerns of sexual minorities on the agendas of policy-makers and health practitioners." Email: info@helem.net. Director's Email: director@helem.net, +961 1 568160 , +961 71 916146 (hotline).

* [http://sidc-lebanon.org Vivre Positif]: "SIDC’s mission is to develop social solidarity by reinforcing healthy behaviour in Lebanon through community empowerment, prevention, harm reduction policies, advocacy, and psychosocial services.The work of SIDC primarily targets the youth and populations that are already affected and/or infected, by anticipating the problems that can mark them and tackling them as needed..." Address: Youssef Karam Street, Daou bldg, 1st floor, 55391 Sin el Fil, Telephone: +961 1 480714, Email: vivrepositif@sidc-lebanon.org

* If you have a yeast infection, you can ask for a generic version of Fluconazole at the pharmacy.

* If you have a UTI, locals say that you can go the pharmacy and get medication without a prescription. You just explain what you think you have or your symptoms and the pharmacist will help you. Ideally, you should still visit a health care professional before self-diagnosing yourself with a UTI since antibiotics are required.

* There is no PrEP (pre-exposure prophylaxis) available in Lebanon.

'''Note:''' In addition to pads and tampons, you can also use menstrual cups and menstrual underwear for your period. To learn more about menstrual cups, click [https://en.wikipedia.org/wiki/Menstrual_cup here]. To learn more about menstrual underwear, click [http://menstrualcupreviews.net/best-period-panties-reviews/ here].

In Beirut, you can primarily finds pads and pantyliners. While some tampons are sold, they are less common and can be expensive. As for menstrual cups, there seems to be no sellers of the major brands (like DivaCup, MoonCup, LadyCup, Lunette, etc.), so it's probably best to buy menstrual cups online.

Organizations working on menstrual issues:

* [https://www.daysforgirls.org/ Days For Girls Lebanon]: "Days for Girls International is a grassroots 501(c)3 non-profit. Women, and girls discover their potential and self-value, are equal participants and agents of social change and are given opportunities to thrive, grow and contribute to their community's betterment while ensuring quality sustainable feminine hygiene." Beirut Lebanon Team - lebanon@daysforgirls.org. Melissa Moody, Leader, Co-Leader. "This new team is looking for sewing and non-sewing volunteers in the Beirut area. Please email us if you are interested."

Here are some recommended clinics/gynecologists in Beirut:

* [http://www.aubmc.org/patientcare/spe_cli_pro_ser/Pages/whc.aspx Women's Health Center @ American University of Beirut Medical Center]: "The mission of the Women's Health Center at AUBMC is to offer quality care to women across their lifespan by providing a wide scope of services, with special emphasis on reproductive health." PO Box 11-0236, Riad El-Solh 1107 2020, Beirut, Lebanon, Email: womenshealthcenter@aub.edu.lb, Telephone: +961-1-759619, Fax: +961-1-350000 ext: 5842.

* Dr Mary Chammas (St George's Hospital, or her clinic in Sodeco Square)

* Dr Antoine Germanos (St Joseph Hospital, and he has a clinic in Jdeideh)

Lebanese women are entitled to 10 weeks of maternity leave. The previous law only allowed seven weeks but, in 2014, the law was changed to allow 10 weeks.

'''Important Note:''' There are two main types of abortions: medical (also known as the "abortion pill") and surgical (also known as "in-clinic"). For medical abortions, you take a pill to induce abortion. For surgical abortions, a procedure is performed to induce abortion. For general information about medical and surgical abortions, click [https://www.plannedparenthood.org/learn/abortion here].

In Lebanon, abortion is generally illegal, as stated in the Penal Code. It is only permitted when the woman's life is endangered by the pregnancy. This means that for all reasons, including to preserve physical health, to preserve mental health, rape or incest, fetal impairment, economic or social reasons, or availability on request, are not permitted.  

Prosecution of abortion laws is under the jurisdiction of the religious courts. If a woman induces an abortion or consents to anyone performing an abortion her, that woman is subject to six months to three years of imprisonment. The person who performs the abortion (with the consent of the woman) is subject to one to three years of imprisonment. If the woman dies during the abortion, the person performing the abortion is subject to four to seven years in prison. If the woman does not consent to the abortion, the person who performed the abortion is subject to five years of forced labor -- and, if the woman died during the abortion (and did not consent), the person who performed the abortion is subject to at least 10 years of forced labor. If someone performed an abortion to "save the honor" of a descendent or relative to the second degree, or if a woman induced her own abortion to preserve her honor, there will generally be a reduced penalty. However, health care personnel typically receive more stringent penalties, and their licenses will be revoked while their businesses may be closed down.<ref>[http://www.un.org/esa/population/publications/abortion/profiles.htm UN Report: Abortion Laws, Lebanon]</ref>  

According to Lebanese law, it is also explicitly illegal to disseminate any information that helps facilitate abortions, or to sell any objects that can help facilitate abortions. If someone does any of these things, they are subject to two months to two years of imprisonment.<ref>[http://www.un.org/esa/population/publications/abortion/profiles.htm UN Report: Abortion Laws, Lebanon]</ref>

Despite the strict laws, women do receive clandestine abortions in Lebanon. According to a 2002 report, "In theory, this law addresses the needs of the Lebanese community and everybody appears to be abiding by it. However, the real picture seems far from this. Experts in the field believe that Lebanese women are constantly breaking the law to accommodate their actual needs (LFPA, 2001). They also claim this violation is well known to policy makers. Yet, they are not willing to act accordingly. For many reasons, they are not ready to modify the law; at the same time, they are not enforcing its implementation but rather turning a blind eye to the perpetrators."<ref>[http://www.theaproject.org/content/abortion-lebanon-practice-and-legality Abortion In Lebanon: Practice and Legality?]</ref>  Furthermore,  The virtual absence of attempts to amend this law ever since, as well as the absence of research concerning its effect on the community, reflects that abortion does not seem to be a public issue of concern."<ref>[http://www.alraidajournal.com/index.php/ALRJ/article/view/461 Abortion In Lebanon: Practice and Legality?]</ref>

Generally, clinics charge $300-600 for clandestine abortions while hospitals charge around $3000. While some abortions are performed in generally hygienic facilities, many more seem to be performed in more run-down, "back-alley" or less hygienic conditions.<ref>[http://www.dw.com/en/bound-by-taboos-lebanese-women-seek-abortions/a-17396085 Bound by taboos, Lebanese women seek abortions]</ref>

Some personal accounts of abortions in Lebanon:

* [http://www.dw.com/en/bound-by-taboos-lebanese-women-seek-abortions/a-17396085 Bound by taboos, Lebanese women seek abortions]

* [https://now.mmedia.me/lb/en/reportsfeatures/lebanons_abortion_question Lebanon's Abortion Question]

There is very little activism around legalization of abortion in Lebanon. There appears to be an attitude of "turning a blind eye" from all sides, whether governmental or social. However, if you are interested in reading a call for the legalization, you can check out the links below:

* [https://ginosblog.com/why-abortion-needs-to-be-legal-in-lebanon-7606e85391fa#.7w3tt4rup Why Abortion Needs to be Legal in Lebanon]

There are no official places to receive abortions in Beirut. If someone is interested in obtaining a clandestine abortion, they should consult with a trusted physician or clinic. If someone is interested in potentially obtaining an abortion outside of Lebanon, legal abortions are performed in [[Turkey]], Greece and Azerbaijan upon request. They are also available in Cyprus for certain circumstances (but, officially, not on request).

* ABAAD Women & Girl's Safe Space - Safe Line: +961 81 78 81 78

* For domestic violence, call Kafa‘s Helpline: 03-018019  

* The A Project Sexuality Hotline: We are open from 5 PM to 11 PM at +961 71 210208. You can also email us at sexualityhotline@gmail.com. "Our hotline is accessible, confidential, and judgment-free. Who picks up the phone? We are volunteers trained in sexuality counseling, who promise you utmost respect and confidentiality."

* [http://www.abaadmena.org/ ABAAD]: "ABAAD is a non-profit, non-politically affiliated, non-religious civil association that aims to achieve gender equality as an essential condition to sustainable social and economic development in the MENA region. ABAAD seeks to promote women’s equality and participation through policy development, legal reform, gender mainstreaming, engaging men, eliminating discrimination, and advancing and empowering women to participate effectively and fully in their communities." Email: abaad@abaadmena.org

* [http://www.theaproject.org/ The A Project]: "The A project is about seeking agency, alternatives and autonomy in sexuality, sexual health, and gender. The project aims to address people living in Lebanon, young and not so young, through various programs. The project aims to work on sexuality, while looking at but not limiting the discussion to disease-prevention and violence, but also through an affirmative and sex-positive framework." Email: mashroualef@gmail.com, Hotline/ Whatsapp: +961 71 210 208, Skype: theaproject, Twitter: @MashrouAlef.

* [https://www.facebook.com/salwa.adventures/ The Adventures of Salwa]: This group may no longer be active. A campaign to fight sexual harassment.

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