43%; p<0.01) but not in the heavier drinking group (55% vs. 59%, p<0.05). More research is needed to understand the connection between alcohol misuse, sexual risk for HIV and HIV screening uptake in the ED setting. Furthermore, patients who report high-risk behaviors, such as those identified in this study, for the acquisition of HIV may need help in recognizing

these connections, reducing their risk behaviors, and accepting HIV testing. Further evaluations of the applicability and efficacy of integrated alcohol misuse and HIV sexual risk interventions within acute settings, such as EDs, is needed to determine effectiveness for this population. Intervention Inhibitors,research,lifescience,medical content regarding sexual risk behaviors in relation to alcohol misuse for ED patients should be evaluated and tested to reduce sexual risk and alcohol misuse and increase

HIV Inhibitors,research,lifescience,medical screening uptake. Limitations This study had a number of limitations. Self-report data regarding alcohol consumption and sexual risk for HIV may be inaccurate. Inhibitors,research,lifescience,medical Study participants may have underestimated or not recalled information regarding their alcohol consumption and HIV testing history. However, self-report of alcohol consumption and sexual behavior can be a reasonable method of obtaining these data [94,95]. Also, we did not collect data on whether or not the participant’s ED visit was related to their alcohol use. We do provide information regarding their level of at-risk drinking. Caspase inhibitor Social desirability factors may have influenced some patients in their responses to reasons for accepting or declining screening, rather than any perception of their risk. Furthermore, Inhibitors,research,lifescience,medical it is unclear whether acceptance of screening based on an opt-out approach in the ED would Inhibitors,research,lifescience,medical be similar for participants who were excluded from the study. However, an opt-out

approach may not be appropriate for patients who are unable to provide study consent. The HIV Sexual Risk Questionnaire has not been validated as a predictor of acquisition of HIV. As such, the true relationship between reported risk and HIV acquisition cannot be determined by this study. In addition, only 15.2% of women and 29.3% of men reported having unprotected sex with a casual partner (with or without an exchange or main partner), and most participants reported only sex with a main sexual partner. As such, the majority of participants of could potentially be considered at lower risk for acquiring HIV, which might have appropriately influenced the uptake of testing. The small sample size may have produced limitations in identifying differences when they do exist. The study outcomes may not be appropriate for other EDs with different demographic characteristics, even though we attempted to obtain a representative sample by randomly selecting dates, shifts and participants.