West Indian Med J 2011; 60 (2): 137 From: 1 Department of Obstetrics and Gynaecology, The University of the West Indies and 2 Comprehensive Clinic, Ministry of Health, Jamaica. Correspondence: Professor HM Fletcher, Department of Obstetrics and Gynaecology, University of the West Indies, Kingston 7, Jamaica, West Indies. Fax: (876) 977-9131, email: horacefletcher@flowja.com, horace. fletcher@uwimona.edu.jm are more common in low socio-economic regions, with the majority of new cases of HIV infection in the world being reported in underdeveloped or developing countries (3) and disproportionately more common in certain ethnic groups (4, 5). The stigmata of promiscuity, irresponsible sexual practices and loose morals attached to these persons are common but probably unfair, as other factors such as those associated with poverty, undernutrition and social vulnerability may contribute to the high incidence in these groups and not just behavioural practices. Poverty, Folate Deficiency, Human Immunodeficiency Virus and Ulcerated Vulval Sexually Transmitted Diseases in Jamaica H Fletcher, P Figueroa, A Brathwaite, T Hylton-Kong ABSTRACT Sexually transmitted genital ulcerative conditions are declining in Jamaica. The rates at present are far lower than that seen in the 1950s – 1960s. Review of the records of the national Comprehensive Clinic has revealed that all of the major sexually transmitted conditions (Syphilis, Lymphogranuloma Venereum (LGV), Chancroid, Granuloma Inguinale and Herpes Simplex) have declined but have had three peaks between 1958 and 2000. Closer review seems to suggest that the peaks were associated firstly with poverty in the 1960s and 1970s and to the HIV epidemic in the 1980s and early 1990s. There are also smaller spikes which appear to be associated with periods of environmental disasters, with a possible association with folate deficiency. This is apparent for the bacterial and chlamydial conditions as well as viral conditions such as Herpes simplex. Keywords: Poverty, HIV, STD Pobreza, Deficiencia de Ácido Fólico, Virus de la Inmunodeficiencia Humana, y la Ulceración de la Vulva por Enfermedades de Transmisión Sexual, en Jamaica H Fletcher, P Figueroa, A Brathwaite, T Hylton-Kong RESUMEN Las condiciones ulcerativas genitales transmitidas sexualmente están disminuyendo en Jamaica. En el presente, los índices son muchos más bajos que los observados en la década de 1950 y 1960 respectiva- mente. La revisión de los archivos de la llamada Nacional Comprehensive Clinic ha revelado que todas las condiciones principales (sífilis, linfogranuloma venéreo, chancroide, granuloma inguinal, y el herpes simple) han disminuido. No obstante, ha habido tres puntos críticos entre 1958 y 2000. Un examen detallado sugiere que estos picos estaban asociados primeramente con la pobreza en los años 60 y 70, y la epidemia de VIH en la década de los 80 ochenta y principios de los 90. Hay también pequeñas alzas que parecen estar asociados con periodos de desastres medioambientales, así como con una posible asociación con la deficiencia de folato. Esto es evidente en el caso de las condiciones bacterianas y clamidiales, así como las condiciones virales tales como la que representa el herpes simple. Palabras claves: Pobreza, VIH, SDT West Indian Med J 2011; 60 (2): 137 INTRODUCTION The sexually transmitted genital ulcerations are important, as the presence of such lesions increase the risk of HIV infec- tion (1, 2). Sexually transmitted infections including HIV,