The re-election of Donald Trump as the next President of the USA has raised serious concerns about the future of US health policy and the response to HIV in the USA and globally. In 2019, Trump announced the Ending the HIV Epidemic (EHE) initiative, with the aim to reduce new HIV infections by 75% by 2025 and 90% by 2030 by targeting the highest burden regions and populations. However, EHE indicators suggest these targets are way off track. Funding pressure on HIV programmes and hostility to the people most affected by HIV have undermined the provision of HIV services not just domestically but through foreign aid, such as the President’s Emergency Plan for AIDS Relief (PEPFAR).