The District of Columbia, an urban area of approximately 600,000 persons, is experiencing a “modern” HIV epidemic—“modern” in its scale and complexity. An estimated 3 to 5% of the total adult population is currently living with HIV or AIDS.  New AIDS rates are the nation’s highest:  at 118 cases/100,000 population, these rates are more than twice as high as New York City, and nearly 4 times as high as Detroit  (51 and 32 cases/100,000, respectively).  Modes of transmission for new HIV diagnoses (2001 to 2006) were:  37% heterosexual, 26% men who have sex with men (MSM), and 15% intravenous drug users (IDU). Racial health disparities are prominent, with 55% of residents but 81% of HIV/AIDS cases being among African Americans. The District is building a “modern” response to its “modern” epidemic, focusing on bold leadership, innovative and comprehensive services, and data-based planning and decision-making.   Key new initiatives include:  scale-up of routine opt-out HIV testing; the DC NEX needle exchange program; comprehensive school-based sex education and sexually transmitted diseases (STD) testing; the DC Condom Program; innovative partnerships for community capacity-building, antiretroviral drug security, and research; strengthening the community prevention response through supports for faith-based leadership, couples-services, and parent-child communications skills. Innovative strategies among long-term HIV primary care providers include a 3-component focus on:  “Navigator” services to link newly diagnosed persons to a medical home; “Recapture” services to bring “lost” clients back into care; and the “Health First” approach utilizing new electronic medical record capacities to direct client-level and clinic-level efficiencies and performance targets.  Cross-cutting all interventions is a priority of making the most accurate data on the epidemic available and usable to all partners, and strengthening routine monitoring and evaluation systems to promote accountability, quality, and effect.