Beyond Road‐Based Systems: Reframing Geography in Global HIV Policy and Delivery

Many countries with dispersed geographies continue to experience persistent barriers to HIV service continuity that are not fully addressed in existing global strategies. In archipelagic, mountainous, riverine, and other climate‐sensitive settings, access to diagnosis, treatment, and prevention is shaped by distance, mobility, and transport disruptions rather than clinical capacity alone. These structural conditions create recurring patterns of delayed diagnosis, treatment interruption, and advanced HIV disease, especially among maritime, mining, and other mobile labour groups. Current HIV guidance is based largely on evidence from road‐connected systems and assumes stable catchments, rapid laboratory transport, and uniform procurement pathways that do not reflect fragmented geographies. To respond to this gap, this commentary introduces the Geo Connect Framework, a policy‐oriented model that aligns service delivery with mobility, decentralised logistics, climate variability, and place‐specific vulnerabilities. Reframing geography as a structural determinant offers practical pathways to strengthen equity, resilience, and progress toward the Three Zeros in geographically complex settings.