U.S. Public Health Service STD Experiments in Guatemala (1946-1948) and Their Aftermath.

The U.S. Public Health Service's sexually transmitted disease (STD) experiments in Guatemala are an important case study not only in human subjects research transgressions but also in the response to serious lapses in research ethics. This case study describes how individuals in the STD experiments were tested, exposed to STDs, and exploited as the source of biological specimens-all without informed consent and often with active deceit. It also explores and evaluates governmental and professional responses that followed the public revelation of these experiments, including by academic institutions, professional organizations, and the U.S. federal government, pushing us to reconsider both how we prevent such lapses in the future and how we respond when they are first revealed.

Despite Being "Known, Highly Promiscuous and Active": Presumed Heterosexuality in the USPHS's STD Inoculation Study, 1946-48.

The Sexually Transmitted Disease Inoculation Study of the United States Public Health Service (USPHS) was a short-term deliberate exposure experiment into the prevention of venereal diseases. Between 1946 and 1948, over 1,300 Guatemalan prisoners, psychiatric patients, soldiers, and sex workers were exposed to syphilis, gonorrhoea, and chancroid. USPHS researchers initially proposed hiring sex workers to "naturally" transmit venereal diseases to male subjects who would then be given various prophylaxes. The researchers were interested in studying the effectiveness of new preventative measures. In other words, the USPHS study was designed to transmit venereal diseases heterosexually from an "infected" female body to the men who, it was assumed, were sexually isolated subjects. However, the researchers did record instances of male-to-male disease transmission among their subject populations, instances that challenged the presumption of heterosexuality on which the study was based.

Effective Reparation for the Guatemala S.T.D. Experiments: A Victim-Centered Approach.

Discussion of reparations for U.S.-Guatemala STD experiments of the 1940s and 50s should be informed by a range of international and U.S. reparation experiences, so that features that impair the effectiveness of repair are avoided, and features that enhance effectiveness of repair are emulated. Two features have contributed to the effectiveness or ineffectiveness of repair elsewhere but have not been critically examined in relation to the Guatemalan experiments: Whether experimental subjects or their families have the opportunity to participate in reparations processes, and whether any group of experimental subjects is intentionally denied recognition. Three advantages of victim participation are explored, and a critique provided of one narrow delimitation of victims. Even if political and moral failings ultimately prevent reparations for Guatemalan experimental subjects, an emphasis on effectiveness and victim-centeredness should nonetheless shape reparations for other, future victims of human rights abuses in experimentation.

Vênus nos braços de mercúrio, bismuto e arsênio Notas históricas sobre sífilis gestacional antes da penicilina / Venus en los brazos de mercurio, bismuto y arsenio: Notas históricas sobre sífilis gestacional antes de la penicilina / Venus in the arms of mercury, bismuth and arsenic: Historical notes on gestational syphilis before penicillin

Resumo Buscou-se neste artigo debater sobre os saberes e as práticas médicas referente à sífilis, em especial à sífilis gestacional, no início do século XX. O objetivo central foi apresentar o debate médico travado em uma das principais faculdades de medicina do país acerca das consequências da sífilis para a mulher gestante e para o feto ou criança. A natalidade foi amplamente defendida por médicos que acabavam por condenar algumas práticas de mulheres que levariam a comprometer a gravidez. A metodologia de análise foi estabelecida a partir de um estudo de caso sobre a tese defendida em junho de 1913, na cadeira de clínica obstétrica, pelo médico recém-graduado Arnaldo Cavalcanti de Albuquerque. Constatou-se pela documentação que os tratamentos do período para sífilis gestacional eram ainda bastantes precários e as anotações médicas extrapolavam os limites clínicos, adentrando muitas vezes no plano de cobrança de valores morais.

Resumen Se buscó en ese artículo debatir sobre los saberes y prácticas médicas referentes la sífilis, en especial a la sífilis gestacional, a principios del siglo XX. El objetivo central fue presentar el debate médico desarrollado en una de las principales facultades de medicina del país acerca de las consecuencias de la sífilis para la mujer gestante y para el feto o niño. La natalidad fue ampliamente defendida por médicos que acababan por condenar algunas prácticas de mujeres que llevarían a comprometer el embarazo. La metodología de análisis fue establecida a partir de un estudio de caso sobre la tesis defendida en junio de 1913, en la cátedra de clínica obstétrica, por el médico recién graduado Arnaldo Cavalcanti de Albuquerque. Se constató por la documentación que los tratamientos del período para sífilis gestacional eran todavía bastantes precarios y las anotaciones médicas extrapolaban los límites clínicos adentrando muchas veces en la dimensión de cobranza de valores morales.

Abstract The aim of this article was to discuss the knowledge and medical practices regarding to syphilis, especially gestational Syphilis, in the beginning of the 20th century. The aim goal is to present the medical debate that took place in one of the main medical schools of the country about the consequences of syphilis for the pregnant women and for the fetus or child. The natality was widely defended by doctors who eventually condemned some practices of women that would lead to compromise pregnancy. The methodology of analysis was established from a study case on the thesis defended in June 1913, in the chair of obstetric clinic, by the recently graduated physician Arnaldo Cavalcanti de Albuquerque. It was found by the documentation that the treatments for the period for gestational syphilis were still very precarious and the medical notes extrapoleted the clinical limits charging several times moral values.

El Sistema de Salud de la ciudad de Buenos Aires en el siglo xix en relación a las enfermedades de transmisión sexual / THE HEALTH SYSTEM IN THE CITY OF BUENOS AIRES DURING THE XIXth CENTURY, RELATED TO THE DISEASES OF SEXUAL TRANSMISSION

The health system of the City of Buenos Aires during the XIX century, related to the diseases of sexual transmission, is presented. The "General Hospital for Acute Diseases Dr. Juan A. Fernandez" of universitary character with a well gained prestige in his influencial zone, accumulates the highest technology in this programmatic area, and is today related with the great epidemic disease of sexual transmission from the XXth. Century: AIDS. Not always is well known the fact that, more than a century ago, this Institution was created to confront also to an epidemic of sexual transmission: syphilis. Is then purpose of this revision to introduce to the reader in the behavioral situation at the time of its foundation, the sanitary problems that conducted to its creation and the history of his former years, all of that related to the evolution of the sexually transmitted diseases at the endings of the XIX century.

Perfil dos pacientes diagnosticados com doenças sexualmente transmissíveis assistidos na Santa Casa de Guaxupé - MG no período de 1923 a 1932 / Profile of patients diagnosed with sexually transmitted diseases assisted at the Santa Casa de Guaxupé - MG, between 1923 and 1932 / Perfil de los pacientes diagnosticados con enfermidades de transmisión sexual atendidos en la Santa Casa de Guaxupé-MG entre 1923 y 1932

Pesquisa histórico-documental cujo objetivo foi descrever as características dos pacientes diagnosticados com doenças sexualmente transmissíveis internados na Santa Casa de Guaxupé, no período de janeiro de 1923 a dezembro de 1932. Utilizou-se, como fonte direta, o Primeiro Livro dos Enfermos da Santa Casa de Guaxupé, que contém registros de pacientes internados nesse período. Como fontes indiretas, foram selecionados artigos que tratam da educação sanitária no país e os que se referem às doenças sexualmente transmissíveis (DSTs). No recorte temporal de janeiro de 1923 a dezembro de 1932, foram assistidos 2.826 enfermos, dos quais 471 foram diagnosticados com DSTs como sífilis e blenorragia. Destes, 278 (59%) eram do sexo masculino e 193 (41%) do sexo feminino. Concluiu-se que a Santa Casa de Misericórdia de Guaxupé atendia principalmente trabalhadores do sexo masculino, dos quais 17% tinham doenças sexualmente transmissíveis (DSTs).

This was a historical-documental research that described the characteristics of patients diagnosed with sexually transmitted diseases and admittedat the Santa Casa de Guaxupé between January of 1923 and December of 1932. The First Book of Patient Records of the Santa Casa de Guaxupé,which contained information on patients admitted in that period, was used as the direct source of data. Indirect sources included papers onnational sanitary education and sexually transmitted diseases (STDs). In the period between January of 1923 and December of 1932, 2,826 patientsreceived care; 471 were diagnosed with STDs such as syphilis and gonorrhea. From this total, 278 (59%) were men and 193 (41%) were women. Itwas concluded that the Santa Casa de Guaxupé mostly provided care for male workers, of whom, 17% carried sexually transmitted diseases (STDs).Keywords: History of Nursing; Sexually Transmitted Disease; Hospital Records.

Investigación histórico documental con el objetivo de describir las características de los pacientes con enfermedades transmitidas sexualmenteinternados en la Santa Casa de Guaxupé entre enero de 1923 y diciembre de 1932. Como fuente directa se utilizó el Primer Libro de los Enfermos dela Santa Casa de Guaxupé que contiene los expedientes de pacientes internados durante dicho período. Como fuentes indirectas se seleccionaronalgunos artículos relacionados con educación para la salud en el país y otros que se referían a las enfermedades transmitidas sexualmente (ETS).Entre enero de 1923 y diciembre de 1932 se contaron 2.826 enfermos, 471 de los cuales fueron diagnosticados con ETS, como sífilis y gonorrea,siendo 278 (59%) varones y 193 mujeres (41%). Se llegó a la conclusión que la Santa Casa de Misericordia de Guaxupé atendía principalmente atrabajadores varones entre los cuales aproximadamente el 17% tenía alguna enfermedad de transmisión sexual (ETS).

"Something of an adventure": postwar NIH research ethos and the Guatemala STD experiments.

The STD experiments in Guatemala from 1946-1948 have earned a place of infamy in the history of medical ethics. But if the Guatemala STD experiments were so "ethically impossible," how did the U.S. government approve their funding? Although much of the literature has targeted the failings of Dr. John Cutler, we focus on the institutional context and research ethos that shaped the outcome of the research. After the end of WWII, Dr. Cassius Van Slyke reconstructed the federal research contracts process into a grant program. The inaugural NIH study section recommended approval of the Guatemala STD experiments at its first meeting. The funding and oversight process of the Guatemala research was marked with serious conflicts of interest and a lack of oversight, and it was this structure, as opposed to merely a maleficent individual, that allowed the Guatemala STD experiments to proceed. We conclude that while current research regulations are designed to prevent the abuses perpetrated on the subjects of the Guatemala STD experiments, it takes a comprehensive understanding of research ethics through professional education to achieve the longstanding ideal of the responsible investigator, and ensure ethical research under any regulatory scheme.

The best possible intentions testing prophylactic approaches on humans in developing countries.

Debates on human experiments in developing countries focus on ethical principles such as informed consent, accountability, involvement of the concerned communities, and the improvement of local health services. Public health specialists who conducted human experiments in Rio de Janeiro (1902-1905) and in Guatemala (1947-1948) believed, however, that they were acting in the best interests of local populations, were aware of the importance of informed consent, were closely collaborating with local health professionals, and were contributing to the development of local health structures. Nevertheless, their investigations went dramatically wrong. An initial desire to conduct ethically and scientifically sound studies was undermined by pressure to obtain results and to save the researchers' initial investment, the possibility of freely using hospitalized patients as experimental participants, uncritical help from local professional elites, and structural pitfalls of experimenting with severely deprived people. These elements can still be found in trials of preventive methods in the Global South.

Ethical evasion or happenstance and hubris? The U.S. Public Health Service STD Inoculation Study.

It's tempting to explain the Guatemala STD inoculation study as an attempt to evade the strictures of U.S research ethics. In fact, the researchers appear to have had benign reasons for going abroad. Only after they reached Guatemala did the study fly out of control.

Historical perspective of sexually transmitted infections and their control in Peru.

In designing an effective national response to sexually transmitted infections (STIs), one must incorporate a historical perspective of previous efforts that have addressed different aspects of STIs. One must understand who have been the key players, what aspects of STIs were the focus of efforts (prevention, treatment or control), and which, if any, societal subgroups were targeted (i.e. sex workers, military, men who have sex with men [MSM], etc.). In addition, one must consider historical and modern attitudes towards sex, sexuality and STIs, especially in terms of taboos and stigmas that may be attached to each. Most importantly, one must recognize which efforts have succeeded, which have failed, and why. This paper presents a historical overview of the perceptions of and responses to STIs at different points in Peru's history, and discusses current efforts to build upon past successes and avoid repeating previous failures that could be helpful for other countries in the Latin American region.