Context: Study works towards resolving the increasing incidence of HIV infection in the southeast United States through the use of a risk-based screening approach to link high-risk HIV negative Emergency Department (ED) patients to primary care. Linkage to care (LTC) for HIV seronegative patients provides education and access to preventative medication such as Pre-Exposure Prophylaxis (PrEP). Objective: A primary LTC initiative for high-risk HIV negative patients presenting in ED in a large vertically integrated healthcare system. Study Design: Quality Improvement Setting: Centrally located metropolitan ED in the Southeast US. Population studied: Patients between the ages of 18 and 64 who present to the ED with STI complaints or for STI testing. Intervention: Screening tool used to identify high risk HIV negative patients that are then referred to primary care. Electronic Medical Record has been updated to include a PowerPlan with multiple STI tests, including HIV, whenever one STI test is ordered. Intent is to increase the number of patients screened. Full-time social worker assigned to the ED with primary responsibility to link newly positive and high-risk negative patients from ED to primary or specialty care. Outcome Measures: Number of patients who are screened for high risk behavior, number of patients who are referred to primary care for HIV education prevention, and the number of patients who completed a visit with a primary care provider. Results: 50 unique ED high-risk patients interested in HIV prevention have been screened, with a total of 53 screening forms completed. The screening scores averaged 15.5 ± 4.5. A total of 86.2% had a risk score > 10. Of those, 18 did not have primary care providers, 1 was newly diagnosed with HIV, and 2 high-risk negative patients have been successfully linked into primary care. Conclusions: Linkage to primary care from the ED for HIV prevention is feasible and important, but systemic hardwiring is needed for routine identification and referral of these patients to continuity care, particularly with follow-up after the patient has left the ED.