Overdue Justice

Establishing adequate reparations for the victims from the U.S. Public Health Service S.T.D. inoculation experiments in Guatemala

by Jazmin Piche Cifuentes

Illustration by Pia Mileaf-Patel

published March 1, 2019

content warning: torture, gore, sexual abuse



The Tuskegee Syphilis Experiments were an infamous and unethical series of clinical studies conducted on about 800 Black men from 1932 to 1972 by the US Public Health Service. White researchers and physicians observed the effects of syphilis on their bodies while withholding verified treatment and lying about the medical tests they performed. In September 2010, then-Secretary of State Hillary Clinton issued a public apology to the then-President of Guatemala Alvaro Colom regarding unearthed records of an unethical medical investigation performed on Guatemalan citizens from 1946 to 1948­­­—conducted by the very same researchers and physicians involved with Tuskegee. US and international observers alike were horrified to learn that another egregious medical experiment had occurred without public awareness, and that only recently had a political apology been  offered.

The apology came seven years after Susan Reverby, a history professor at Wellesley College, discovered records detailing the studies while researching material from the 1932 to 1972 Tuskegee Syphilis Experiments. Dr. John Cutler, a US Public Health Service (USPHS) physician associated with Tuskegee and one of the head researchers for the STD Inoculation Studies in Guatemala, had donated his data to the University of Pittsburgh postmortem after serving an extensive role as its dean of the Public Health School. His data chronicled the study and included photographs of the Guatemalan victims, their individual profiles, laboratory reports, and correspondence with officials from USPHS.

Despite the initiation of an investigation by the US Presidential Commission on Bioethical Issues, the USPHS STD Inoculation Studies in Guatemala from 1946-1948 remain an obscure event for the majority of the American population. This is likely due to the lack of a successful settlement after demands for the USPHS and its partners to provide accountability and reparations to the victims of the investigations went unmet. In the case of the Tuskegee experiments, a class-action lawsuit was initiated for the 600 victims used as unconsenting subjects following its revelation and termination. The plaintiffs ultimately won a $10 million settlement after three years on August 28, 1975. In comparison, the lawsuit by families of the Guatemalan victims has taken over seven years to complete. The arduous process began in 2012 after the US Presidential Commission on Bioethical Issues published their findings and confronted multiple dismissals. Nevertheless, the lawsuit was recently approved in January 2019 and reparations will finally be granted.


Revisiting the STD Inoculation Studies in Guatemala, 1946-48


The inoculation studies, initiated in 1946 by US Public Health Service researchers, focused on STDs in an attempt to support the US military. Throughout World War II, soldiers would contract gonorrhea and syphilis while assigned abroad in Europe, taking them out of service for prolonged if not permanent amounts of time. In an attempt to efficiently confront the STD infection rates among American troops, the US government decided it was crucial to investigate a prophylactic, or preventative, medication. Despite the potential benefits that come with studying a prophylaxis, there exists a major ethical obstacle: researching a prophylaxis demands an introduction of the disease(s) in question to previously unexposed human subjects. The solution the US government chose to follow eventually led to the most egregious aspects of the STD Inoculation Studies in Guatemala. Instead of creating a study with consenting and properly compensated human subjects, USPHS exploited vulnerable Guatemalan citizens and purposely infected them with syphilis, gonorrhea, and chancroid.

The US had a powerful presence in Central America by way of the United Fruit Company from 1899 to 1975. The relationship between United Fruit Company and Central American politicians depended on two economic-political principal elements: the ability of the banana sector to generate economic stability and the strength of the labor movement in the host country. The company had demonstrated its value by constructing an export economy with efficient production and distribution networks of bananas between Central America and the US, consisting of large plantations, railways, communication lines, housing, hospitals and ports in the production regions. As a benefit to the working relationship with Central America, the United Fruit Company and the US, by extension, possessed many privileges in the region because governments were eager to attract foreign capital in order to stimulate their stagnant economies. One privilege in particular was frequent communication with each Central American country’s upper elite to protect their own interests and influence. Per this strategy, the US forged communication with Guatemalan scholars in addition to the country’s leaders so as to establish projects that benefitted the US.

Guatemala was chosen as the specific site for the studies because Juan Funes, a Guatemalan physician in correspondence with Dr. John Cutler during the Tuskegee Syphilis Experiments, had the capacity to provide the socioeconomic resources to various institutions with vulnerable populations such as Guatemalans of indigenous descent, prisoners, and mentally ill patients that were excluded from society due to racism, ableism, or social stigma. This provided assurance that the general public would neither suspect nor question the unethical treatment. For example, prostitution was legal in Guatemala at the time, so sex workers were brought into a men’s prison by US researchers as further conduits to discreetly spread the STDs. However, due to the taboo against sex work in Guatemalan society, the communities surrounding the prison did not investigate the sudden presence of sex workers. The sex workers thus became another group of nonconsenting victims in this unethical, transcontinental study. Other victims included orphans and soldiers. As Dr. Culter explained in his proposal to the USPHS, Funes worked with the Pan-American Sanitary Bureau (now the Pan-American Health Organization) to accomodate a penitentiary, an orphanage, a mental hospital, and army barracks for the studies in order to exploit their inhabitants.

The doctors employed numerous methods to intentionally infect the Guatemalans. Aside from using sex workers to infect study participants, the doctors also inoculated orifices such as penises, urethras, and eyes, fabricated wounds on faces and limbs for additional infection sites, and introduced infectious substances into their spines. The STDs had multiple adverse effects on the Guatemalan victims. One account that the US Presidential Commission on Bioethical Issues reported in their published work, Ethically Impossible, discussed a woman named Berta. Syphilis was injected in her left arm. A month later, she developed red bumps around her injection site, and then developed lesions on her limbs. Berta was consequently given treatment three months after her injection; yet, three months later, Dr. Cutler noted that she was likely going to die. The same day he wrote the note, experimenters recorded a procedure in which they poured gonorrhea pus in her eyes and re-infected her with syphilis. Afterwards, her eyes overflowed with discharge, and she bled from her urethra. Berta’s death was recorded a few days later. Her death was not anomalous—a total of 83 deaths were reported during the course of the studies.

In spite of all the information documented, neither Dr. Cutler nor the USPHS published any records of the STD Inoculation Studies in Guatemala. This is likely a consequence from the sudden halt of the investigations in 1948 which remains unexplained in Dr. Cutler’s and any other related work. It should be noted that in Dr. Cutler’s work, he alluded to plans to eventually return to Guatemala to finish the experiments. The hypothetical return likely would have harmed more Guatemalans, given that the researchers needed to replace the 83 subjects that had already died.


The Current Lawsuit


Despite many hurdles posed by legal proceedings, justice may be served for the now deceased victims and their families 70 years after the start of the experiments. The Office of Human Rights for the Archdiocese of Guatemala, represented by the UC Irvine School of Law International Human Rights Clinic and the City Project of Los Angeles filed a petition in the Inter-American Commission on Human Rights in December of 2015. Titled “Overdue Justice for Guatemalan Victims of Venereal Disease Experiments,” it stated that the Guatemalan victims and their families’ rights to life, health, freedom from torture, and crimes against humanity under both the American Declaration of the Rights and Duties of Man and the American Convention on Human Rights were violated. Jessnia Ovalle, an attorney in Guatemala working for the Office of Human Rights for the Archdiocese of Guatemala, explained on City Project’s website that the objective of this 2015 petition was to obtain “truth and justice for the Guatemalan victims’ families of these experiments through comprehensive and dignified reparations.”

In an earlier attempt for reparations in March 2011, the District of Columbia Court of Appeals decided that the pleas of the victims’ families were not valid, given that the responsible governmental authorities had already left office. In September of 2016, the civil lawsuit appeared in court for the first time. It categorized victims into six separate categories: people who were infected as part of the study; the estates of deceased direct victims; spouses; first-generation descendants; subsequent generation descendants; and relatives whose deaths were caused by diseases contracted from the study. Most prominently, the lawsuit demanded $1 billion in reparations from the Johns Hopkins University, the Rockefeller Foundation, and Bristol-Myers Squibb due to their prominent roles in the STD Inoculation Studies.

The lawsuit claimed Johns Hopkins University doctors held key roles on panels that reviewed and approved federal spending for the experiments; the Rockefeller Foundation assisted in developing “Department L,” a Hopkins clinic and research center focused on syphilis, and four corporate officers of Bristol-Myers Squibb’s predecessor companies, Bristol Laboratories and E.R. Squibb & Sons Inc.’s Squibb Institute for Medical Research, also undertook key roles in the development process.

US District Judge Marvin J. Garbis, a federal judge in Baltimore, dismissed the lawsuit. Yet he proposed that the victims’ lawyers re-filed the case by October 14, 2016. Garbis said the suit, filed on behalf of 842 victims (nearly all deceased) and their family members, did not include the sufficient amount of detail about their cited claims. Citing the “despicable nature” of the study, Garbis said lawyers could file a revised complaint once more details about how and when victims were infected were affixed. Particularly, he said the lawsuit necessitated more information from at least one victim from each of the six categories.

In the amended complaint, which appeared in court in August 2017, attorneys provided the specified details as requested by US District Judge Marvin J. Garbis, including accounts of which disease the victims contracted, when, and how they realized they had been infected. One account was from a prisoner who stated he was injected with what was promoted as “vitamins.” Another recounted the story of a family member whose child was infected with the same ailments as their spouse. A few of the remaining victims were not aware they were part of the studies until President Barack Obama’s public apology to reaffirm the importance of the US relationship with Guatemala in 2012. The lawsuit was ruled to proceed and a planning meeting for the case was scheduled for September 15, 2017. At that time, the attorneys were able to move onto the discovery process.

This year, the lawsuit had a momentous victory when US District Judge Theodore Chuang ruled last month that Bristol-Myers Squibb, Johns Hopkins University and the Rockefeller Foundation must face a $1 billion lawsuit over their roles, rejecting arguments from the defense that a recent Supreme Court decision protecting foreign companies from US lawsuits over human rights abuses abroad also applied to domestic firms. The details in regard to how the reparations will be overseen and distributed are not yet finalized, nor are they public.


Demanding More Than an Apology


The United States has a long history of subjugating Latin America that continues to this day; the scope of this article only touches upon a fragment of this legacy. We need only to look to the US’ instituionalized policy of rejecting Latinx immigrants as opposed to European immigrants, the interventionist portrayal of the Venezuelan crisis by American media, and the deterioration of relations with Cuba to see as much. Latin America is uniquely interwoven into the United States’ economy, culture, and politics—in turn, more significant apologies than the ones offered by Clinton and Obama are due. The harm and deaths inflicted upon Guatemalans were hidden for 64 years. In total, it has taken the Guatemalan victims 70 years to receive adequate reparations for their nonconsensual participation in a US-funded and executed study. A statement is only ever the beginning. Announcing culpability, then working with the exploited population to determine the reparations they need are the crucial subsequent steps. These actions can thus begin to address historically oppressive US-Latin American relationships, but perhaps even more importantly, prepare the US to properly address other horrifying accounts of human rights abuse that may not yet be public.


JAZMIN I. PICHE CIFUENTES B‘19 wants you to ask about her earring collection.