Despite advancements in HIV prevention and treatment, disparities persist across the U.S. that are geographically and demographically unique. This study analyzed HIV burden and prevention efforts in three urban counties, Suffolk County, MA (Boston), Orange County, FL (Orlando), and Philadelphia County, PA (Philadelphia), using AIDSVu data. We assessed HIV prevalence, new diagnoses, Pre-Exposure Prophylaxis (PrEP) use, PrEP-to-Need Ratio (PnR), and key social and structural determinants of health (SSDoH) to contextualize local trends within national patterns. Findings revealed significant disparities. For the three counties, Philadelphia exhibited the highest overall HIV prevalence and lowest PrEP uptake, while Orange County reported the highest rate of new diagnoses. Demographic groups, socioeconomic factors, including poverty, insurance coverage and housing instability, further shaped HIV outcomes across these regions. These results highlight the need for evidence-driven interventions, expanded PrEP access, and policy reforms to HIV prevention and care in high-burden communities.