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American Journal of Public Health – First, Do No Harm: US Sexually Transmitted Disease Experiments in Guatemala

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First, Do No Harm, a commentary piece written by Michael A. Rodriguez and Robert Garcia, examines the unethical practices and procedures practiced by the U.S. Government during the 1940s, when U.S. doctors and medical researchers infected vulnerable populations with bacteria that caused sexually transmitted diseases without their informed consents. This week, the authors sit down with AJPH Talks to discuss the experiment’s ramifications and results.

Q: Can you describe the Guatemalan STD Experiments?

Rodriguez and Garcia: Beginning in 1946, U.S. Public Health Service investigators in Guatemala, funded by the National Institutes of Health, engaged in immoral, unethical, and illegal experiments infecting victims with bacteria that cause sexually transmitted diseases, without the victims’ informed consent. The U.S. has left the victims untreated and uncompensated to the present day.

Q: Who was affected?

Rodriguez and Garcia: The STD experiments involved at least 5,128 vulnerable people, including children, orphans, child and adult prostitutes, Guatemalan Indians, leprosy patients, mental patients, prisoners, and soldiers. Health officials intentionally infected at least 1,308 of these people with syphilis, gonorrhea, and chancroid, and conducted serology tests on others.

Dr. John Cutler, who was later responsible for the Tuskegee experiments that left African American men untreated for syphilis for decades, led the STD experiments in Guatemala. U.S. officials worked with the cooperation of Guatemalan authorities – which excuses nothing. [Continues after break.]

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Q: How were the studies conducted?

Rodriguez and Garcia: The experiments were not conducted in a sterile clinical setting in which bacteria that cause STDs were administered in the form of a pin prick vaccination or a pill taken orally. The researchers systematically and repeatedly violated profoundly vulnerable individuals, some in the saddest and most despairing states of life, and grievously aggravated their suffering.

For example, Cutler infected Bertha, a female patient in a psychiatric hospital, by injecting her with syphilis in her left arm. A few months later Cutler put gonorrheal pus from a male subject into both her eyes, her urethra, and her rectum, and reinfected her with syphilis. Several days later, her eyes were filled with pus, and she was bleeding from the urethra. She died a few days later.

Such actions constitute the crimes of rape, battery, assault, and conspiracy. The actions are also crimes against humanity. The actions violate the principles of the Nuremberg Code that the U.S. established under international law through the trial, conviction, and execution of Nazi doctors in 1947 and 1948 – while the U.S. was conducting the experiments in Guatemala.

Q: Why did the US Government (the NIH) support this method of research?

Rodriguez and Garcia: The STD work began on prisoners in the US but researchers could not consistently cause infections. One stated reason for moving to Guatemala was that prostitution was legal there, as it was in Paris, France.

The Guatemalan government in its published report concludes that the STD experiments were crimes against humanity, and that racism and discrimination permeated the experiments. The US reports do not analyze discrimination, or the legality of the experiments under domestic or international law. There was discrimination by US officials against Guatemalan people, and within Guatemala by elites against lower-class indigenous and non-indigenous people. Discrimination is an aggravating, unacceptable factor for the experiments.

Q: What has been currently done to compensate the victims?

Rodriguez and Garcia: Nothing.

The victims were intentionally infected and have been left without treatment or compensation to the present day. The experiments were covered up until 2010. President Barack Obama then apologized to the president of Guatemala.

By contrast, the victims in Tuskegee were already infected, but were left without treatment or compensation beginning in the 1930s until the 1970s when litigation, organizing, and media attention resulted in compensation. The Tuskegee payment structure should be made available to the Guatemalan victims (with different payments for each living victim, surviving dependent, and heirs of deceased victims).

Human rights attorneys filed suit on behalf of the class of Guatemalan victims and their survivors. The federal district court dismissed the suit on technical grounds of sovereign immunity – in other words, the US did not agree to be sued. The court wrote that the victims could seek redress from Congress and the President. They have done nothing.

Q: What are some further steps that need to be taken by the U.S. Government to help rectify this terrible ordeal and to ensure that this never happens again?

Rodriguez and Garcia: The US government should provide treatment and compensation to the victims. Human rights and health foundations should help provide funding for the victims, as they do in other contexts where government fails.

It is critical to adopt legal and ethical reforms to protect individuals in improper human experiments, waive sovereign immunity for federally funded human research in the United States and abroad, ensure that parallel protections apply to privately funded research, and respect autonomy and equality for all. US training programs should analyze the Guatemala experiments under domestic and international law. Ethical and moral arguments are not enough to deter misconduct. Although two US reports have recommended some reforms in ethical training, the recommendations have yet to be implemented.

The US government should publish the reports by the Guatemala government in English to ensure the voice of the Guatemalan people is heard.

International tribunals should provide relief to the victims so that the US does not act with impunity when it engages in unethical, immoral, or illegal human rights experiments.

Q: Where can we go to learn more about this situation?

Rodriguez and Garcia: To learn more about the Guatemala STD experiments, please visit the City Project website, located at: /blog/archives/14794.

Reference: Michael A. Rodriguez and Robert García.  First, Do No Harm: The US Sexually Transmitted Disease Experiments in Guatemala. American Journal of Public Health: December 2013, Vol. 103, No. 12, pp. 2122-2126. Click here to download the article in English. Click here to download the article in Spanish.  Translation / traducción Border Philanthropy Partnership / Alianza Fronteriza de Filantropía.