Administrative hurdles, costs, and provider resistance have prevented many EDs from implementing the kind of nontargeted HIV screening that the CDC recommends. However, some of the hospitals that have successfully negotiated through these obstacles are having a positive impact on their communities, identifying cases of HIV at a time when many of the downstream complications and costs can be prevented. Further, once an infrastructure is in place to support HIV screening, it can be used for other purposes as well. Since the ED at the University of Alabama at Birmingham implemented non-targeted HIV screening a year ago, the process has identified 72 patients with HIV and linked them into care. Administrators caution that it is imperative to identify resources for follow-up care before HIV testing begins; otherwise the benefits of testing will be lost. Experts advise EDs to make testing as routine as possible so that patients will agree to undergo HIV tests. At UAB, triage nurses explain to all patients that the HIV test will be conducted unless they choose to decline the test.The decline rate is only 13%. New, fourth-generation testing platforms have reduced the per-test costs by more than half, and can deliver results within 30 minutes.