Ending the HIV Epidemic:
What It Is, What It Does,
and What's at Risk
Last reviewed:
In 2019, the federal government launched Ending the HIV Epidemic in the U.S. (EHE), aiming to reduce new HIV infections by 90% by 2030. Seven Florida counties are priority jurisdictions. The initiative builds on existing HIV services and depends on sustained funding, staffing and access to care.[1]
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.
EHE was announced in the February 5, 2019 State of the Union address and continued with bipartisan congressional support. Its original goals were a 75% reduction in new HIV infections by 2025 and 90% by 2030, measured from a 2017 baseline. These are infection goals, not simply counts of new diagnoses. HHS agencies coordinate the initiative.[20][1]
EHE’s initial selection used 2016–2017 diagnosis data: more than half of new diagnoses occurred in 48 counties or county equivalents, Washington, DC, and San Juan, Puerto Rico. Seven additional states met rural-burden criteria, making 57 priority jurisdictions. This historical selection should not be presented as a current measurement of where every new infection occurs.[2]
🌍 Why Seven States Were Selected for Rural HIV Burden
The seven states are Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma and South Carolina. HIV.gov describes the selection criteria as at least 10% of new diagnoses in rural areas in 2016–2017, at least 75 diagnoses statewide, and no separately selected priority county. The designation addresses rural needs without implying that these states have no urban epidemic.[3]
📋 Show all 57 EHE priority jurisdictions (48 counties + DC + San Juan + 7 rural states)
Source: HIV.gov priority-jurisdiction list — updated September 8, 2026; checked September 20, 2026.
EHE supports local prevention and care capacity, including testing, navigation, surveillance and response. The mix of staff and services varies by recipient. Its purpose is to diagnose HIV sooner and connect people with effective prevention and care; a programme description does not guarantee that every county has a dedicated federal employee or a fixed response time.[20]
↑ 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.
EHE is a federally coordinated U.S. initiative funded through appropriations. Fast-Track Cities is a global partnership launched at Paris City Hall on December 1, 2014, with IAPAC, UNAIDS, UN-Habitat and the City of Paris. Twenty-six cities initially signed the Paris Declaration. An October 2024 Fast-Track Cities Institute presentation described a network of more than 550 cities worldwide.[4][5][6]
Led by: U.S. HHS — CDC, HRSA, NIH, IHS, OASH, SAMHSA
Scope: Initial focus on 57 U.S. priority jurisdictions
Framework: Four pillars — Diagnose, Treat, Prevent, Respond
Target: 75% fewer new infections by 2025; 90% by 2030 (2017 baseline)
Funding: Annual congressional appropriations — not permanent
Diseases: HIV only
Led by: City mayors, with IAPAC + UNAIDS + UN-Habitat
Scope: 550+ cities reported in October 2024
Framework: Paris Declaration (4th iteration, April 2021)
Target: 95-95-95 and zero stigma, toward ending the epidemic by 2030
Funding: Voluntary commitment; funding varies by city and partner
Diseases: HIV + TB + viral hepatitis (2021 declaration)
Where They Overlap
Both frameworks support testing, prevention, treatment and community engagement. Their goals align with reducing stigma and improving health. U=U means that a person who maintains an undetectable viral load does not transmit HIV through sex; the message should retain that route-specific meaning.[22]
Where They Differ
EHE operates through federal programme funding and appropriations. Fast-Track Cities is a voluntary commitment by local leaders, supported by a global network. Signing its declaration does not automatically award a U.S. federal grant; participating cities may combine local, national, philanthropic and other resources. The 2021 declaration addresses HIV, tuberculosis and viral hepatitis.[7]
🌴 Miami-Dade: Both Frameworks, One County
Miami-Dade is both an EHE priority jurisdiction and a signatory to the Fast-Track Cities declaration. IAPAC’s 2019 account also lists San Francisco, Washington, DC, Baltimore, Atlanta/Fulton County, New Orleans and Providence. The frameworks can support coordination, but membership alone does not demonstrate a specific local funding amount or improved outcome.[21]
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 has four complementary strategies: Diagnose, Treat, Prevent and Respond. They operate together; prevention for someone without HIV does not wait for that person to pass through diagnosis and treatment.[20]
The four pillars reinforce one another. Diagnosis should lead to care that protects a person’s health; sustained suppression also prevents sexual transmission. Prevention and outbreak response need accessible services and trusted relationships. Weakness in one area can undermine progress elsewhere.[20][22]
↑ Back to navigationFlorida and EHE: Seven Counties, High Stakes
Florida’s seven EHE priority counties are Broward, Duval, Hillsborough, Miami-Dade, Orange, Palm Beach and Pinellas. EHE added targeted resources to an existing network of HIV prevention and care; these communities had services before 2019.[9]
Seven Florida Counties Targeted for Intensive HIV Resources
The seven counties are eligible priority areas for targeted EHE activities. Programmes can support testing, prevention, navigation and response. Check local providers for current services; the designation does not establish that each county has dedicated CDC staff stationed there.[9]
Florida reported 4,463 HIV diagnoses in 2024, with a rate of 19.4 per 100,000. EHE services work alongside Ryan White, ADAP and other coverage. As of this review, Florida ADAP provides medication assistance for eligible people up to 400% of the federal poverty level; insurance-premium assistance has not been restored.[19][10]
The Compounding Effect
Navigation and medication coverage need to work together. Florida’s earlier 2026 ADAP restrictions raised serious concerns, but current rules differ: Biktarvy and Descovy were restored effective July 1, 2026, and the state lists medication assistance up to 400% of the federal poverty level. Loss of premium assistance can still leave broader care gaps. The extent of medication interruption and any effect on viral suppression require outcome data.[19]
⚠️ Florida Was Selected Through Seven Counties
Florida was selected through its seven priority counties, not the separate rural-state category. Areas outside those counties still have other potential HIV funding and services, including Ryan White and state programmes. The designation alone does not quantify each rural county’s funding or outcomes. Read about HIV in rural communities →[9]
Progress Made — and What It Took to Make It
National incidence estimates and programme service counts provide different views of progress. Neither should be confused with a causal evaluation proving how much change was produced by EHE alone.[11]
CDC estimated 12% fewer new infections in 2022 than in 2018 (31,800 versus 36,200), not a 12% drop in diagnoses between 2019 and 2022. Its 2024 release also reported a 21% incidence decline in EHE phase-I jurisdictions from the 2017 baseline to 2022. These dated estimates cannot determine whether the 2025 target was achieved.[11]
EHE supports people returning to care as well as those newly diagnosed. HHS’s FY2026 budget documentation reports that EHE-funded providers served 26,830 clients new to care and an estimated 20,940 re-engaged in care in 2023. These are reported service counts, not estimates of infections prevented.[15]
📊 The COVID Disruption
CDC documented a sharp fall in HIV testing during 2020 and cautioned against interpreting the accompanying diagnosis decline as an equivalent reduction in new infections. Those findings describe the pandemic period; they do not establish how much of any testing backlog remains in 2026.[12]
Reaching the 2030 goal requires faster progress in prevention and sustained care. National 2024 surveillance documented viral suppression for 69% of people with diagnosed HIV. That leaves substantial work, while missing or unreported results should not automatically be labelled treatment failure.[23]
↑ Back to navigationThe Threats to EHE in 2025–2026
September 28, 2026 funding update: Temporary federal funding runs through December 11, unless applicable appropriations become law sooner.[24] HIVMA’s analysis of the House committee proposal distinguishes level-funded CDC EHE from the proposed elimination of the Ryan White EHE allocation. Neither is a final full-year appropriation.[25] See the current funding deadline and act →
EHE depends on annual appropriations, programme staffing and local delivery. Budget requests, enacted funding and actual service changes are different kinds of evidence and should be tracked separately.[14][16]
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.
Residents of Miami-Dade, Broward, Duval, Hillsborough, Orange, Palm Beach and Pinellas can ask their federal representatives about EHE funding and local implementation. People elsewhere can advocate for HIV prevention and care too. Ask about specific appropriations, grant delivery and access to services rather than relying only on proposal headlines.[18]
📞 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. EHE overview: 2019 launch and original infection-reduction goals. Source. ↩
- HIV.gov. Priority jurisdictions, updated September 8, 2026; selection based on 2016–2017 diagnoses. Source. ↩
- HIV.gov. Rural-state selection criteria and seven-state list. Source. ↩
- HIV.gov. Federal EHE overview and coordination. Source. ↩
- IAPAC. Paris and Sevilla Declarations: launch and evolution. Source. ↩
- Fast-Track Cities Institute. Sindhu Ravishankar presentation, October 2024: 550+ cities. Source. ↩
- Paris Declaration, fourth iteration, April 13, 2021. Source. ↩
- CDC. Vital Signs: HIV transmission along the care continuum, model for 2016. MMWR 2019. Source. ↩
- HIV.gov. Florida’s seven EHE priority counties. Source. ↩
- Florida Department of Health. FLHealthCHARTS EHE dashboard: 2024 diagnoses and rate. Source. ↩
- CDC. May 2024 surveillance release: 2018–2022 incidence and EHE-jurisdiction change from 2017. Source. ↩
- CDC. HIV testing before and during COVID-19, United States, 2019–2020. MMWR 2022. Source. ↩
- HHS. March 27, 2025 restructuring announcement; not a local EHE workforce inventory. Source. ↩
- HRSA. FY2015–FY2026 Ryan White appropriations, reviewed May 2026. Source. ↩
- HHS. FY2026 Budget in Brief, HIV/AIDS section: 2023 EHE service counts and requested funding. Source. ↩
- HHS. FY2026 Budget in Brief: administration proposal, distinct from enacted appropriations. Source. ↩
- HRSA. Ryan White and ADAP appropriations by year. Source. ↩
- HIV.gov. EHE priority-jurisdiction list for constituent reference. Source. ↩
- Florida Department of Health. ADAP current eligibility, July 1, 2026 formulary restoration and premium-assistance exclusion. Source. Checked September 20, 2026. ↩
- CDC. EHE goals and four complementary strategies. Source. Checked September 20, 2026. ↩
- IAPAC. February 7, 2019: U.S. Paris Declaration signatories, including Miami-Dade. Source. Checked September 20, 2026. ↩
- CDC. Treatment as prevention: maintained viral suppression prevents sexual HIV transmission. Source. Checked September 20, 2026. ↩
- CDC. National HIV prevention and care objectives: 2024 care-continuum data. Source. Checked September 20, 2026. ↩
- Public Law 119-103, temporary FY2027 appropriations, section 106. Reviewed September 28, 2026. Source. ↩
- HIV Medicine Association, House FY2027 Labor-HHS bill analysis, June 15, 2026. Reviewed September 28, 2026. Source. ↩