Recent empirical research, and a simple stochastic modeling exercise, suggest that affluent suburban communities are at increased risk for the diffusion of HIV from present inner city epicenters, while the 'core group' construct of sexually transmitted disease theory suggests, somewhat counter-intuitively, that the hypercongregated and strongly self-interacting nature of affluent heterosexual elites in the U.S. places them at significant and increasing risk as well. In turn, a growing body of work strongly associates high HIV prevalence in minority urban populations with the processes of coupled physical and social disintegration which have produced the now-common and politically-generated 'hollowed out' pattern of U.S. cities. We conclude that a return of the principles of the Great Reform Movement, which first brough public health and public order to U.S. urban areas, is a necessary, but at present largely unrecognized, component to any successful national program to control AIDS in the United States, and particularly to stem the diffusion of HIV into heterosexual populations outside present diseases epicenters.