According to UNAIDS, the United States (U.S.) has a concentrated HIV epidemic, primarily among men who have sex with men (MSM and injection drug users) (IDUs). While the HIV epidemic has not had a broad impact on the general U.S. population, it has greatly affected the economically disadvantaged in many urban areas. We sought to characterize the HIV epidemic in impoverished urban areas of the U.S. and determine whether the epidemic in these areas meets the UNAIDS definition of a generalized epidemic.