In French Guiana, health inequalities are patent for a broad range of pathologies for all age groups. The objective of the present study was to quantify the proportion of the population that had renounced care in the past year, to study predictive factors, and to compare results with other French territories. A two-stage random sample of 2015 individuals aged 15 to 75 years was surveyed by telephone. A descriptive analysis of variables relative to renouncing care, use of health care, screening, and vaccination was initially performed. Multivariate analysis was then used to determine variables associated with renouncing care for financial reasons and renouncing for reasons linked to time were directly estimated using a Poisson model on weighted data. Variables with a significance level < 0.2 in the bivariate analysis were included in the full multivariate model. In French Guiana, during the past 12 months, 30.9% of surveyed persons renounced care whatever the type for financial reasons. Results of the multivariate analysis showed that gender, perceived financial situation, perceived health and complementary insurance status were independent predictive factors of care renouncement for financial reasons. Overall, 24% of the surveyed population declared having renounced to care for time-related motives. The independent predictors for time-related renouncing were different than those for renouncing care for financial reasons: a higher education level and a poor perceived health were independently associated with time-related renouncement; retired persons and students were found to renounce care less frequently than persons with a job. Renouncing for financial reasons, a major target of the 2016 health law, represented a public health problem in French Guiana. Renouncing for lack of time was an important motive for renouncing, which is aggravated by the insufficient number of health professionals, but may benefit from organizational solutions. There are avenues for improvement of health for the most vulnerable: promote health, act on risk factors, and facilitate the readability and accessibility of the health system. Recent reforms to stabilize health insurance may however have some adverse consequences for migrants.

Access to health care is a global public problem. In French Guiana, there exists social inequalities which are specially marked amongst immigrants who make up a third of the population. Health care inequalities are prevalent. The objective of this study was to determine factors associated with why health care amongst the poor population of Cayenne was renounced. The study was cross sectional. It focused on knowledge, attitudes, practices and beliefs of the population living in poor neighborhoods of the Cayenne area. Populations coming at the Red Cross mobile screening unit in poor urban areas of Cayenne were surveyed from July 2013 to June 2014. Structured questionnaires consisted of 93 questions. Written informed consent was requested at the beginning of the questionnaire. The predictors for renouncing medical care were determined using logistic regression models and tree analysis. Twenty percent of persons had renounced care. Logistic regression showed that renouncement of health care was negatively associated with having no regular physician Adjusted Odds Ratio (AOR) = 0.43 (95 % CI = 0.24–0.79) and positively associated with being embarrassed to ask certain questions AOR = 6.81 (95 % CI = 3.98–11.65) and having been previously refused health care by a doctor AOR = 3.08 (95 % CI = 1.43–6.65). Tree analysis also showed that three of these variables were linked to renouncement, with feeling shy to ask certain questions as the first branching. Although most people felt it was easy to see a doctor, one in five had renounced health care. The variables identified by the models suggest vulnerable persons generally had previous negative encounters with the health system and felt unwanted or non eligible for healthcare. Health care mediation and welcoming staff may be simple solutions to the above problems which were underscored in our observations.

In the complex context of French Guiana, different vulnerabilities and different risk factors between genders may lead to complex differences in health outcomes, mortality, and life expectancy. Our aim was, thus, to compare male and female mortality and life expectancy, to compare it between French Guiana and mainland France, and to look at temporal trends and the main specific causes of death in order to identify actionable singularities. National databases were used to obtain life expectancy at birth, at 20, 40, and 60 years, and mortality statistics. Standardized death rates and causes of death for French Guiana and mainland France were obtained through the CEPIDC, which analyzes information from death certificates. When comparing with mainland France, life expectancy at birth was significantly shorter both in males and females (mean = −2.9 years); life expectancy at 20 years, which allows to remove the effect of the greater child mortality in French Guiana, was also shorter in French Guiana for males (mean = −1.8 years) and females (mean = −2 years). The differences between mainland France and French Guiana regarding life expectancy at 40 and 60 years (mean = −1.5 and −1.3 years) was mainly found among females, males in French Guiana life expectancy at 40 and 60 years was closer to that in mainland France (mean = −0.8 and −0.6 years). Although they have a greater life expectancy at birth than men, women in French Guiana are substantially more affected by overweight/obesity and type 2 diabetes. The observed patterns of life expectancy at different ages presumably reflect the burden of external causes and AIDS in males and perhaps metabolic diseases in women.

The drivers of the HIV epidemic, the viruses, the opportunistic infections, the attitudes and the resources allocated to the fight against HIV/AIDS, vary substantially across countries. French Guiana, at the crossroads between Amazonian South America and the Caribbean, constitutes a singular context with poor populations and rich country health funding, which has allowed researchers to gather lots of information on the particulars of our epidemic. We aimed to focus on the little known story of forty years of HIV research in French Guiana and emphasize how local research intertwined with public health action has yielded continuous progress, despite the difficult social conditions of the affected population. We searched Web of Science and associated local experts who worked through much of the epidemic in selecting the most meaningful products of local research for clinical and public health outcomes in French Guiana. Research tools and facilities included, from 1991 onwards, the HIV hospital cohort and the HIV-histoplasmosis cohort. Ad hoc studies funded by the ANRS or the European Regional Development fund shed light on vulnerable groups. The cumulative impact of prospective routine collection and focused efforts has yielded a breadth of knowledge, allowing for informed decisions and the adaptation of prevention, testing and care in French Guiana. After this overview, we emphasize that the close integration of research and public health was crucial in adapting interventions to the singular context of French Guiana.

Background: The population of French Guiana is young, poor, and multicultural. We thus hypothesized that the epidemiology of depression and its care may differ from that in mainland France. We took the opportunity of the Mental Health in the General Population survey to estimate the overall prevalence of depression in the general population and its prevalence in different sociodemographic subgroups using the MINI interview. Methods: The cross-sectional survey was conducted 881 persons aged > 17 years were interviewed and analyzed. Results: There were 151 current depressive episodes setting the prevalence at 17.1% (95% confidence interval = 14.8–19.8%). For recurrent depression, the prevalence was 7.9% (95% confidence interval = 6.3–9.9%). The prevalence of current depression was independently greater among younger age groups than those aged 65 or more (age ≤ 25 years (aPR = 4.4 (95% CI = 1.5–12.3), p = 0.004); age 26–35 years (aPR = 3.3 (95% CI = 1.2–9), p = 0.01) persons who did not complete primary education (aPR = 1.9 (95% CI = 1–3.5), p = 0.04), those who earned less than EUR 840 (aPR = 2 (95% CI = 1.1–3.8), p = 0.04), and those who were separated or divorced relative to those married or in a couple (aPR = 2.2 (95% CI = 1.1–4.5), p = 0.02). For recurrent depressive episodes, multiple Poisson regression found that younger age categories relative to those aged > 65 years ≤ 25 years (aPR = 9.9 (95% CI = 1.1–85.9), p = 0.04), those aged 26–35 years (aPR = 9.3 (95% CI = 1.1–78.9), p = 0.04), and female sex (aPR = 2.04 (95% CI = 1.2–3.4), p = 0.007) were independently associated with the outcome. Conclusions: Depression is more frequent in French Guiana than in mainland France and is strongly associated with youth and poverty.