Three months, twelve months, five years, or forever. What is the right amount of time to wait after a man has sex with a man before he can safely donate sperm? Or is this the wrong question?
Currently, gay and bisexual men can't donate blood in Canada unless they have abstained from sex with men for at least one year. Last week, Health Canada announced that that is about to change. As of June 3, that "deferral" period will be reduced to three months. The change comes as a result of better testing for infectious diseases.
The same testing can be done on men wanting to donate sperm. But when it comes to sperm donation in Canada, men who have sex with men are still not welcome. And not just men who've had sex with men in the last three months or one year — in Canada at present, any man who has had sex with a man, even once, since 1977 is barred from the regular donation process. "People who want to be donors are being excluded," says Art Leader, of the Ottawa Fertility Centre.
These rules are set out in the semen regulations, part of the Food and Drugs Act, and were drawn up more than two decades ago, when screening by self-report played a big part in keeping sperm safe, says Leader. (From 1992 until 2013, there was a similar ban on donating blood.) But these days, as last week's change in blood donor policy reflects, there are quick and accurate tests for detecting viruses such as HIV, hepatitis B and hepatitis C.
But revised sperm donation policy is unlikely to match blood donation policy. Last autumn, Health Canada acknowledged that the current regulations are "outdated" and they promised an upgrade. They proposed adding diseases like Zika and West Nile to the test list, aligning our testing with that of the US and Europe, and allowing a wider variety of modern test kits.
They also proposed that when friends want to donate — even those "who would otherwise be excluded from donating," such as, you know, men who'd had sex with men even once since 1977 — they could do so through a much less cumbersome process, called directed donation. The new regulations, when they finally come out, will be housed within the Assisted Human Reproduction Act.
Exactly what these new regs will say on the matter of men who have sex with men is not yet clear. They might stipulate a deferral of six months, something that was recommended by a team working under the auspices of the Canadian Standards Association. Leader, who chaired that team, and who supports a lifting of the lifetime ban, points out that there is still one virus, HTLV, that poses a theoretical risk in semen and must be screened for, but currently takes a little longer than others to detect.
Inconsistencies between blood and semen policies are not unique to Canada. Sally Greenwald, at the University of California at San Francisco, and her colleagues criticized the same type of discrepancy in the US in their 2016 commentary, "The Exclusion of Sperm Donation on the Basis of Sexual Practices: Time for a Policy Update." They drew attention to a 2015 change to a Food and Drug Administration guideline. The old one, from 1983, recommended that men who'd had sex with men in the previous five years be excluded from donating tissue and sperm, and the new one reduced that to one year — but only for blood, not sperm.
The authors say that dramatic improvements in infectious disease screening technology make such deferrals unnecessary. Furthermore, singling out one group for deferral — men who have sex with men — is simply discriminatory, they argue. In North America, men who have sex with men do, as a group, have a higher rate of HIV infection than heterosexual men. But men who are in long-term monogamous same-sex partnerships are at no more risk than any other monogamous person.
Several countries have moved to blood donor policies that screen for behaviours — such as having multiple sexual partners, regardless of whether those partners are same or opposite sex. Write Greenwald et al: "We were unable to find evidence that excluding men who have sex with men... decreases the false negative rate of laboratory testing."
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