Ending the HIV Epidemic:
What It Is, What It Does,
and What's at Risk
Last reviewed: September 2026
In 2019, the federal government launched an ambitious plan to reduce new HIV infections in the United States by 90% by 2030. It's called Ending the HIV Epidemic — and for seven Florida counties, it meant targeted federal resources for testing, treatment, and prevention that didn't exist before. Now the initiative is under threat.
What Is Ending the HIV Epidemic?
EHE is a domestic U.S. federal initiative — not a global program. It was designed to concentrate HIV resources precisely where the epidemic is most concentrated, rather than spreading funding thin across the country.
Ending the HIV Epidemic (EHE) was launched by President Trump in the February 5, 2019 State of the Union address, and continued under President Biden with bipartisan support.[1] The goal is straightforward and ambitious: reduce new HIV diagnoses in the United States by 75% by 2025 and by 90% by 2030. The initiative is coordinated across the Department of Health and Human Services, primarily through the CDC, HRSA, NIH, and the Indian Health Service.
EHE was built on a specific insight from HIV surveillance data: more than 50% of all new HIV diagnoses in the US occur in just 48 counties (across 19 states), plus Washington DC and San Juan, Puerto Rico. On top of those 50 high-burden urban jurisdictions, seven states were added specifically because of their disproportionate rural HIV burden — states where the epidemic is spread across counties rather than concentrated in one metro area. Together that makes 57 priority jurisdictions.[2] Rather than spreading resources equally across the country, EHE concentrates funding, personnel, and programs precisely where the data shows the epidemic is most concentrated.
🌍 Why the South Has Entire States — Not Just Counties
In urban areas, HIV is concentrated enough that individual counties qualify. In the South, the epidemic is spread across rural counties — no single county hits the threshold, but the entire state does. Seven states qualified this way: Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma, and South Carolina. These states receive EHE resources statewide, with a focus on rural communities, smaller towns, and areas without major HIV specialty clinics.[3]
📋 Show all 57 EHE priority jurisdictions (48 counties + DC + San Juan + 7 rural states)
Source: HHS/HIV.gov — Updated March 20, 2025
EHE is not just a funding program — it brought with it infrastructure: dedicated epidemiologists, disease intervention specialists, HIV testing teams, navigation workers, and data systems. That infrastructure is what allows communities to identify new diagnoses quickly, link people to care within days, and track suppression rates over time. It is also exactly what is vulnerable to budget cuts and federal staffing reductions.
↑ Back to navigationEHE vs. Fast-Track Cities: What's the Difference?
EHE isn't the only initiative working toward the same 2030 goal. Cities around the world — including several EHE priority jurisdictions — have signed onto a separate, city-led framework called Fast-Track Cities. Understanding how the two overlap helps explain why some communities have two layers of HIV infrastructure working in parallel.
Ending the HIV Epidemic is a federal U.S. initiative, coordinated by HHS agencies and funded through Congress.[4] Fast-Track Cities is a global, mayor-led coalition launched on World AIDS Day, December 1, 2014, at Paris City Hall, with IAPAC, UNAIDS, UN-Habitat, and the City of Paris as founding partners.[5] What began with 26 founding cities has grown to more than 500 cities and municipalities on six continents that have signed the Paris Declaration on Fast-Track Cities.[6]
Led by: U.S. HHS — CDC, HRSA, NIH, IHS, OASH, SAMHSA
Scope: 57 U.S. priority jurisdictions only
Framework: Four pillars — Diagnose, Treat, Prevent, Respond
Target: 75% reduction by 2025, 90% by 2030
Funding: Annual congressional appropriations — not permanent
Diseases: HIV only
Led by: City mayors, with IAPAC + UNAIDS + UN-Habitat
Scope: 500+ cities on 6 continents
Framework: Paris Declaration (4th iteration, April 2021)
Target: Originally 90-90-90 by 2020; now 95-95-95 by 2030
Funding: Voluntary — local city budgets + IAPAC/UNAIDS technical support
Diseases: HIV + TB + viral hepatitis (added 2018/2021)
Where They Overlap
Both frameworks are data-driven and prioritize the places where HIV is most concentrated. Both scale up PrEP, testing, and treatment; both lean on U=U (Undetectable = Untransmittable) messaging to reduce stigma and encourage viral suppression; and both explicitly name stigma reduction and community engagement as core strategies, with the shared goal of ending HIV as a public health threat by 2030.
Where They Differ
The biggest difference is who is in charge and who pays. EHE is a U.S. federal program subject to Congress — it can be expanded, flat-funded, or cut based on annual appropriations decisions. Fast-Track Cities is a voluntary political commitment that mayors sign; there's no federal money attached, so participating cities fund their own local response with technical support from IAPAC and UNAIDS.[7] EHE is also U.S.-only and HIV-specific, while Fast-Track Cities is global and, since 2018-2021, covers HIV, tuberculosis, and viral hepatitis together.
🌴 Miami-Dade: Both Frameworks, One County
Miami-Dade County is an EHE priority jurisdiction and a Fast-Track City that has signed the Paris Declaration — along with other U.S. cities including San Francisco, Washington DC, Baltimore, Atlanta, New Orleans, and Providence. In places like Miami-Dade, the two frameworks reinforce each other locally: federal EHE dollars fund testing and navigation infrastructure, while the city's Fast-Track Cities commitment adds a political platform and access to global technical support and peer-city learning.
Neither framework replaces the other — they operate at different levels of government and answer to different funders. But for a county like Miami-Dade, being part of both means more eyes on the same 2030 finish line. Read our Fast-Track Cities article for the global picture →
↑ Back to navigationThe Four Pillars of EHE
EHE is built around four strategies that work in sequence — you have to diagnose before you can treat, and you have to treat before you can reach undetectable. Each pillar depends on the ones before it.
The four pillars work as a system. A new diagnosis caught through Pillar 1 needs a navigator from Pillar 2 to get into care before they transmit to others. PrEP from Pillar 3 doesn't help if the person at risk doesn't have a provider. An outbreak response from Pillar 4 is meaningless without the testing and linkage infrastructure to back it up. When any piece is cut, the whole system degrades.
↑ Back to navigationFlorida and EHE: Seven Counties, High Stakes
Florida has one of the highest rates of new HIV diagnoses in the country — and seven of its counties were designated as EHE priority jurisdictions from day one. For these communities, EHE wasn't abstract federal policy. It was people, programs, and services that didn't exist before 2019.[9]
Seven Florida Counties Targeted for Intensive HIV Resources
These seven counties receive targeted federal funding for HIV testing, care navigation, PrEP access, and outbreak response. They also benefit from dedicated CDC epidemiologists and disease intervention specialists stationed locally — staff who track new diagnoses in real time, follow up on positive tests, and connect people to care before they fall through the cracks.
Florida consistently ranks among the top three states in the country for new HIV diagnoses, and has the largest ADAP program in the nation.[10] EHE resources in these counties were designed to work in concert with Ryan White-funded clinics and ADAP coverage. The 2026 ADAP cuts landed directly on top of EHE infrastructure — reducing the treatment access that EHE's Diagnose and Treat pillars depend on.
The Compounding Effect
Florida's situation illustrates what happens when multiple HIV programs are cut simultaneously. EHE funds the infrastructure to find and link people to care. Ryan White and ADAP fund the care itself. When ADAP cuts off 16,000 people from medication coverage at the same time that EHE funding is uncertain, the two crises compound each other: EHE navigators are linking people to care that is no longer fully funded, and the viral suppression rates that EHE is measured on deteriorate regardless of how good the navigation is.
⚠️ Rural Florida Is Not a Priority State — But Other Southern States Are
Florida qualified for EHE through its high-burden urban counties, not as a rural priority state. The seven states added specifically for rural HIV burden are Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma, and South Carolina — states where HIV is spread across counties rather than concentrated in metros. Rural Florida — particularly north-central counties with some of the worst HIV outcomes in the state — falls outside both categories and receives far less targeted federal support. Read about HIV in rural Florida →
Progress Made — and What It Took to Make It
EHE has produced measurable results. New HIV diagnoses in the US declined during the initiative's early years — though the COVID-19 pandemic disrupted progress significantly. The work is unfinished, and the infrastructure built to do it is now at risk.
Between 2019 and 2022, new HIV diagnoses in the US declined by approximately 12% — not enough to hit the 75% reduction target by 2025, but real progress in communities that had seen years of flat or worsening numbers.[11] The HIV testing expansion under EHE led to earlier diagnoses, shorter time from diagnosis to treatment initiation, and improved viral suppression rates in several priority jurisdictions.
EHE also funded something less visible but equally important: workforce. Disease intervention specialists (DIS) who follow up on positive HIV tests and help link people to care. Epidemiologists who track clusters in real time. Community health workers who reach people who don't come to clinics. This workforce was built specifically for HIV response — and it doesn't exist in most places without federal investment.
📊 The COVID Disruption
The COVID-19 pandemic significantly disrupted EHE progress. HIV testing volumes dropped sharply in 2020 as clinics closed or shifted to COVID response. People already in care skipped appointments. New diagnoses appeared to decline in 2020 — but much of that was a testing artifact, not real progress.[12] The backlog of undiagnosed infections created during the pandemic is still being worked through in EHE priority jurisdictions.
The 90% by 2030 target was always ambitious. Most HIV experts acknowledged it would require sustained investment, no major program disruptions, and continued political will. All three of those conditions are now in question.
↑ Back to navigationThe Threats to EHE in 2025–2026
EHE requires annual congressional appropriations — it has no permanent funding. It also depends on a federal workforce and data infrastructure that has been disrupted by staffing cuts across HHS, CDC, and HRSA. The combination is serious.
EHE Depends on Political Will — And That Depends on You
EHE was created by a bipartisan federal initiative and has been funded through annual appropriations. It can be expanded, maintained, or eliminated based on what Congress and the executive branch prioritize. That priority is shaped by constituent pressure.
If you live in one of Florida's seven EHE priority jurisdictions — Miami-Dade, Broward, Duval, Hillsborough, Orange, Palm Beach, or Pinellas county — you are directly represented by members of Congress who vote on EHE appropriations every year.[18] Calls, letters, and constituent visits from people living with HIV and their allies have historically moved HIV funding votes.
📞 Make the Call
Use the RiseUpToHIV Take Action page to find your U.S. Senators and Representative with direct phone numbers and ready-to-use call scripts for HIV funding. Find your reps and call scripts →
🌴 Find HIV Care in Florida
EHE-funded programs in Florida's priority counties include testing sites, care navigation services, and PrEP providers. Use our Florida care locator to find HIV services near you. Find HIV care in Florida →
References & Sources
- HIV.gov. "What Is 'Ending the HIV Epidemic in the U.S.'?" — overview of the initiative's Feb. 5, 2019 launch and bipartisan continuation. hiv.gov ↩
- HIV.gov. "Ending the HIV Epidemic: Jurisdictions." List of the 48 priority counties, Washington DC, San Juan, and 7 rural priority states. hiv.gov ↩
- HIV.gov. "Ending the HIV Epidemic: Jurisdictions" — detail on the 7 rural priority states (Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma, South Carolina). hiv.gov ↩
- HIV.gov. "Ending the HIV Epidemic in the U.S.: Overview" — federal HHS coordination across CDC, HRSA, NIH, IHS, OASH, and SAMHSA. hiv.gov ↩
- IAPAC. "Paris and Sevilla Declarations on Fast-Track Cities." Founding partners and Dec. 1, 2014 Paris City Hall launch. iapac.org ↩
- UNAIDS. "More Than 200 Cities Commit to Fast-Track Actions to Help End the AIDS Epidemic" — press release archive on the Fast-Track Cities network's growth. unaids.org ↩
- UNAIDS. "Paris Declaration on Fast-Track Cities Ending the AIDS Epidemic" — full declaration text, 4th iteration updated April 2021 to include TB and viral hepatitis. unaids.org (PDF) ↩
- CDC. HIV surveillance estimates on undiagnosed infection and transmission from people unaware of their HIV status. cdc.gov ↩
- HIV.gov. "Ending the HIV Epidemic: Jurisdictions" — Florida's seven EHE priority counties: Broward, Duval, Hillsborough, Miami-Dade, Orange, Palm Beach, Pinellas. hiv.gov ↩
- CDC. "HIV Diagnoses, Deaths, and Prevalence" surveillance data by state; see also Florida Department of Health HIV/AIDS surveillance. cdc.gov · floridahealth.gov ↩
- HIV.gov / CDC surveillance data on national HIV diagnosis trends, 2019–2022, and progress toward EHE's 2025 target. hiv.gov ↩
- CDC. HIV testing volume disruption during the COVID-19 pandemic and its effect on 2020 diagnosis trends. cdc.gov ↩
- KFF. "Domestic HIV Funding in the White House FY2026 Budget Request" — federal workforce and program impacts at CDC and HRSA. kff.org ↩
- HRSA. "Ryan White HIV/AIDS Program: Budget" — EHE line-item funding history, $70M (FY2020) to $165M flat (FY2023–FY2026). ryanwhite.hrsa.gov ↩
- KFF. "Domestic HIV Funding in the White House FY2026 Budget Request" — cross-agency EHE funding peak of approximately $573 million in FY2023. kff.org ↩
- KFF. "Domestic HIV Funding in the White House FY2026 Budget Request" — analysis of the FY2026 budget request preserving EHE funding despite an earlier OMB proposal to eliminate it. kff.org ↩
- HRSA. "Ryan White HIV/AIDS Program: Budget" — Ryan White and AIDS Drug Assistance Program (ADAP) funding trends. ryanwhite.hrsa.gov ↩
- HIV.gov. "Ending the HIV Epidemic: Jurisdictions" — list of Florida's EHE priority counties for constituent advocacy reference. hiv.gov ↩