This was a prospective cohort study involving an ED rapid HIV screening program targeting high risk patients. 1090 patients underwent ED HIV testing over a 33 month period. 43% (467/1090) were male and 74%(804/1090) were African American. Mean age was 27 years. 32/1090 tested positive of which 31 were confirmed on follow up testing (3%; 95%CI, 2-4%). 27/31 patients were previously undiagnosed (87%; 95%CI, 71-95%), while 4 patients had reported prior positive results.100% of HIV positive patients were linked to outpatient care. ED testing, including linkage to outpatient care is feasible, and yielded higher rates of HIV than previously reported.