In September 2006, the Centers for Disease Control and Prevention released its revised recommendations for human immunodeficiency virus (HIV) testing. Prominent among these were the recommendations that emergency departments should perform routine screening for HIV infection. This report outlines the steps needed to set up an emergency department-based HIV screening program based on these guidelines. It contains the lessons that were learned when such a program was initiated at an academic emergency department. Consideration of these steps will help streamline the establishment of the program, but there should be careful consideration of the program's costs and sustainability before embarking on the process.