Researching human sexual orientation has never been easy. The legal and social opprobrium of same-sex attraction and behaviour up to and during the twentieth century meant that people were reluctant to discuss such matters. Even after the liberalisation of attitudes in North America, Western Europe and Australasia, research participants were hesitant to report such intimate details of their lives. Thus, our knowledge of the nature and prevalence of same-sex desire and behaviour has always remained sketchy at best. However, things are changing rapidly in the West. Recent surveys of British youth have found a greater openness about sexual orientation and gender, coupled with a rejection of identity categories such as gay, lesbian or straight (Waldersee, Reference Waldersee2019). This frankness has led to a greater understanding of the relationship between sexuality and mental health in all people. However, it is easy to forget that either little has changed, or things have become even worse in many parts of the world. Nowhere is this better seen than in the Islamic Republic of Iran which recommends the death penalty for some same-sex behaviour. Iran's first penal code in 1925 brought together the structure of the Napoleonic Code and the content of Shia-Islamic jurisprudence (Karimi & Bayatrizi, Reference Karimi and Bayatrizi2018). But, same-sex offences in this early penal code mainly concerned non-consensual acts between men of different social (and domestic) positions such as employer and servant. It took some years after the Iranian revolution in 1979 for the law to change, but in 1991 sweeping new sexual prohibitions were introduced including out-lawing same-sex acts between women. It was heavily influenced not only by religion but also by the medicalisation of homosexuality in the West during the twentieth century (Forbes, Reference Forbes2016–2017). However, Article 234 of the most recent Iranian law amendment in 2013 is distinctive in that it distinguishes between a man who penetrates and one who is penetrated. Capital punishment no longer applies to the former unless he has used coercion or is a non-Muslim who has penetrated a Muslim man.

This then is the context in which this survey was undertaken by researchers living in Iran, who risked serious sanction in doing so. It also highlights the dangers for participants, who were reporting illegal behaviour. The extent of opposition to same-sex behaviour in Iran means that such data would be highly sensitive if they fell into the wrong hands. For example, it would have been useful to know other facts which bear on mental health such as how many were married, how many other people knew of their sexual orientation, their current same-sex partnership status and the frequency and nature of harassment by police, the public or other authorities. However, participants and researchers would have been fearful of identification if they had collected or published such information. Thus, although not ideal in its method, the survey provides a glimpse into the mental health of sexual minority men in Iran. In reporting the detail of same-sex behaviour, it reveals the nonsense of a law that reserves the most draconian punishments for particular sexual acts, such as being penetrated. Most men in this survey reported being ‘versatile’ with regard to their sexual behaviour. Penetrating or being penetrated are stereotypical concepts that have little salience for same or opposite sex behaviour. It has been known since at least the 1990s that while 30 to 60% of gay men have anal sex, up to one-third of heterosexuals report the same behaviour (Halperin, Reference Halperin1999; Rosenberger et al., Reference Rosenberger, Reece, Schick, Herbenick, Novak, Van Der Pol and Fortenberry2011; Voeller, Reference Voeller1991). Even in Iran, 25% of women report having participated in anal intercourse (Hashemi, Seddigh, Tehrani, Khansari, & Khodakarami, Reference Hashemi, Seddigh, Tehrani, Khansari and Khodakarami2013), a practice that also carries a possible death sentence. Thus, this odd legal distinction for men also reveals the emphasis Iranian sexual laws place on narrow, patriarchal concepts of masculinity and femininity. Programmes of ‘treatment’ in Iran either attempt to make gay men heterosexual or to accept medical and surgical gender transition to fit the stereotype that to be a male homosexual is to adopt a ‘female’ role. Up to 45% of sex change operations in Iran appear to be performed on homosexuals (hamjensgaryan) to ‘correct’ their sexual orientation disturbance (Forbes, Reference Forbes2016–2017).

Given this history and cultural background, it is little surprise that the rates of mental distress and suicidality were higher in this snowball sample of gay men than in the general Iranian population. However, from another angle, the findings are not entirely negative. The mental health of gay men in Iran is as good as or better than that of their peers in western society (King et al., Reference King, Semlyen, See-Tai, Killaspy, Osborn, Popelyuk and Nazareth2008; Plöderl & Tremblay, Reference Plöderl and Tremblay2015). This may be because of a sense of camaraderie among an excluded minority who support each other covertly. Or it might be due to changing attitudes at the grass roots level. Through everyday acts of defiance, gay and lesbian Iranians are pushing boundaries in ways that echo the wider defiance and opposition of women and youth to state-defined norms on dressing and dating (Karimi, Reference Karimi2018; Karimi & Bayatrizi, Reference Karimi and Bayatrizi2018). Or it may be due to methodological issues such as selection bias in that the network of men who took part in this snowball sample were protected by their connections and higher educational status.

We cannot know for sure but, as the authors stress, such cruel and excessive legal sanctions on men and women who happen to love others of the same sex need to be overturned. This might best be achieved by sustained, sensitive dialogue with local activists and politicians rather than from hostile intervention from global organisations or other nations (Karimi & Bayatrizi, Reference Karimi and Bayatrizi2018). At least eight countries continue to recommend the death penalty for same-sex behaviour between men. This extreme infringement of human rights needs to end.