Additionally, care must be taken in generalizing from our results. The higher rates of HIV prevalence found in urban settings, such as inner-city Chicago, where this study was conducted, may affect the applicability of our results to settings that have lower rates of HIV seropositivity. Also, HIV testing services are guided by state-specific regulations and hospital-specific practices. By state law, our institution requires written consent before all HIV testing and does not release reactive EIA results until confirmatory Western blot testing has been completed, except for study purposes, mothers in labor, and occupational exposures. Under the study protocol guiding the rapid testing of patients in the ED, a health educator obtained consent from patients, performed pretest counseling, drew blood, performed the rapid HIV test, and provided the patient with results, posttest counseling, and necessary referrals. Conventional testing practices followed a less efficient algorithm consisting of a provider ordering the test, a counselor obtaining consent from patients, a phlebotomist drawing blood, the laboratory running the EIA, and providers being notified via posting of results in the electronic record after positive confirmatory testing. While astute clinicians hindered by delays in laboratory reporting of conventional EIA results may use other markers—presence of oral thrush, high-risk behaviors, CD4 cell counts—to assess patients, this approach may not be adequate for inexperienced providers or overworked house staff. Existence of the testing inefficiencies noted above that may have resulted in discharging patients without disclosure of their HIV diagnosis has prompted reevaluation of HIV result reporting practices at our institution.