A bisexual man walks into a blood donor clinic. In a lengthy questionnaire, he affirms that, among other things, he has not had sex with a man in the past year. Half an hour and half a litre of blood later, with cookies and some juice as thanks, he will be on his way. The same man offering to donate sperm, however, will be turned down. That’s because while there is a required abstinence period for men who have sex with men (MSM) wanting to donate blood, there is a lifetime ban when it comes to sperm.
Both policies are poised to change. Earlier this month, Health Canada announced that, as of June 3, that deferral period for MSM donating blood will drop to three months. So far, however, it has stayed mum on sperm. While it acknowledged last October that its policy on sperm donation was “outdated” and published some proposed changes, it has so far not indicated whether those changes would include allowing gay men to become regular donors.
The ban on MSM donors dates back to the mid 1980s, as an attempt to protect the blood supply from HIV. At that time, Canada placed a lifetime ban on donations of blood, and subsequently sperm, from any man who’d had sex with a man, even once, since 1977. In 2013, the policy on blood changed to allow MSM to donate, so long as five years had elapsed since their last sexual encounter with a man. In 2016, that deferral period dropped to one year. In June, it will be reduced again, to three months.
This month’s shortening of the deferral period for MSM wanting to donate blood comes partly as a result of better testing for infectious diseases. Newer testing, known as nucleic acid testing (NAT), can detect the presence of genetic material from HIV within about 10 days of infection. In Canada, all blood is NAT-tested for HIV and hepatitis B and C, among other things. To be on the safe side, blood is also tested for antibodies to these infections, which your body generates in response. Antibodies can take a few weeks to be detectable. All that to say, three months is enough time for evidence of infection to show up in the blood.
But the change in deferral is also a result of communication between the LGBTQ2 community and patients who rely on donated blood. Both groups have been vocal with Health Canada in support of change, says Mindy Goldman, at Canadian Blood Services. “This is another incremental step,” Goldman explains. “It’s not where we want to end up.”
The policy on MSM and sperm, however, has not budged. “People who want to be donors are being excluded,” says Art Leader, professor of obstetrics, gynecology and reproductive medicine at the University of Ottawa and founder of the Ottawa Fertility Centre.
Inconsistencies between blood and semen policies are not unique to Canada. A few years ago, Sally Greenwald and her colleagues at the University of California at San Francisco criticized the same type of discrepancy in the US. In 2015, a new Food and Drug Administration (FDA) guideline was introduced. The old one, dating back to 1983, recommended that men who’d had sex with men in the previous five years be excluded from donating; the newer one reduced that to one year — but only for blood, not sperm.
The authors argued that singling out one group — MSM — for deferral of any length was discriminatory. In North America, MSM 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, for example, are at no more risk than any other monogamous person. Some countries, like Italy and Spain, screen blood donors according to a broader personal risk profile — such as having multiple sexual partners.
Goldman says that several research projects in Canada, as part of a $3 million federal initiative, are currently looking at the question of how to screen more fairly, and two are focusing on the donation of plasma — the liquid part of blood that is used to make products like albumin and immune globulin. Plasma donations are where donation criteria are likely to change first, she says. For one thing, plasma can be frozen and stored. If all donations for a six month period come back clean, then it can be deemed safe.
That sounds a lot like what happens with regular sperm donation in this country. It made me wonder: if sperm is quarantined for six months anyway, why would any deferral period be necessary for any donor? When I put that to Leader, he replied, “Good question.”
The rules on who can and cannot donate sperm, and what testing is required, are currently set out in the semen regulations, which is part of the Food and Drugs Act. (The plan is to move the regulations into the Assisted Human Reproduction Act.) Testing to keep sperm safe is done differently from testing to keep blood safe. Blood donations are tested individually for antibodies and in batches of six for genetic evidence of viruses. If evidence of infection is found, the batch is discarded and the infected donor is identified and notified. In sperm donation, by contrast, a donor is screened more extensively up front, both physically and psychologically, then donates regularly — sometimes once a week. The donor himself is currently blood-tested for infectious disease each and every time he donates. The semen is then frozen and quarantined for six months. Semen is only released for use when all his blood tests for the preceding half year come back clean. Despite this — and despite the fact that there is an acute shortage of sperm donors in Canada — MSM are flat out not accepted as donors.
Even if a revision to Canada’s sperm rules ends up lifting the lifetime ban on MSM donors — and that is by no means guaranteed — it is likely to come with a deferral period longer than the one on blood. A team working under the auspices of the Canadian Standards Association, led by Leader, recently recommended a six-month deferral. The rationale was that antibodies to the viruses HTLV1 and HTLV2, which can cause cancer, and are a larger transmission concern in sperm than in blood, can take up to six months to become detectable; there is so far no NAT for them. But, again, six months in quarantine should take care of that.
One thing Health Canada has proposed, however, is to make it easier for MSM to donate to people they know. It is already possible for MSM to donate to friends, under the “donor semen special access program,” but this currently involves a special application to Health Canada and a six-month quarantine of frozen sperm. Under the newly proposed option, called “directed donation”, both those requirements would be dropped. Donors in this new category would still be screened, tested and physically examined, but the clinic would have the authority to accept the donor, without special approval from Health Canada, by making note of why he would have been otherwise considered unsuitable and why his sperm doesn’t pose a risk to the recipient or the potential child. As with blood donation policy, this would be an incremental but welcome change.
We will have to wait and see exactly what ends up in the final sperm regulations. Will the ban on MSM as regular donors become a six-month deferral? Maybe. Will the ban be scratched out altogether? Don’t count on it. But these are baby steps. The new sperm regulations are expected no later than June 21.