Health geographics, epidemiology and the emergence of HIV treatment deserts

UNAIDS has set treatment targets for ending the HIV pandemic by 2030, and an additional goal of eliminating current inequities in access to treatment. Before inequities can be overcome, they need to be found and their underlying causal factors identified. We show how this is possible by analyzing data from Malawi, which has one of the most severe HIV epidemics worldwide. We find significant geographic inequities in access to treatment, and dozens of treatment opportunity deserts: areas where there is only a very low opportunity to access treatment. Surprisingly, some deserts are in urban areas. We provide a parsimonious explanation for the emergence of deserts. If deserts are not targeted, when increasing treatment coverage, existing geographic inequities in access will be greatly exacerbated by 2030.