French Guiana remains the French department most affected by HIV. Transmission there is primarily heterosexual, with an equal number of men and women affected. Although the proportion of patients of foreign origin is high, a significant portion of infections are believed to have been acquired in French Guiana. Despite screening efforts, the proportion of infections diagnosed at a very advanced stage remains stable (30% in Cayenne and 45% in Saint-Laurent-du-Maroni). Although there is an overall slowdown in the growth of active cases, in western French Guiana, the annual number of new HIV and AIDS diagnoses is trending upward. In French Guiana, the most common opportunistic infection is disseminated histoplasmosis. Among patients followed in 2018, 91% were on antiretroviral therapy, of whom 94% had an undetectable viral load. However, a significant number of patients remain lost to follow-up. While there appears to have been significant progress, reducing the hidden reservoir of undiagnosed infections is difficult and remains the priority in the fight against HIV in French Guiana.