In 2001 and then again in 2006, the Centers for Disease Control and Prevention (CDC) published guidelines recommending universal HIV screening in acute care settings, including emergency departments (EDs). The value of early identification and treatment of HIV-infected patients is clear, but the most effective method for accomplishing this has yet to be determined. In this article, published experiences by ED-based HIV screening programs are reviewed to learn lessons from their mistakes and accomplishments. The goal of this article is to encourage thought regarding previous experiences with HIV screening and future ideas for improving efforts to this end. By examining the variety of HIV testing kits available, the debate regarding targeted testing versus screening, the consent and patient education requirements, and the staffing models used to implement HIV testing in the ED, this review aims to provide emergency physicians and administrators with options that can be tailored based on the resources available in their specific venue.