More Care is moving into California’s EDs.
Emergency departments (EDs) are increasingly a primary point of contact with the healthcare system for a growing share of the US population, delivering close to half of all hospital-associated medical care. EDs are also tasked with providing a growing amount of primary and preventive care for Americans who are either uninsured or face barriers to alternative forms of care. California is no exception. In 2005, the state’s EDs saw 10.2 million visits. In 2025 they saw 15.5 million, a rise of more than 50 percent. Far ahead of the state’s population growth. For many patients, namely those who are under or uninsured and those without stable housing, the ED is not a backup. It is the front, and oftentimes only, door to health care.
California ED visits keep climbing
Total emergency department encounters, all California hospitals, 2005–2025
Source: Department of Health Care Access and Information (HCAI), ED facility pivot profiles, 2005–2025.
Despite the role that EDs play in healthcare access, particularly among vulnerable communities, they remain underused in national efforts to screen for sexually transmitted infections. The need is substantial. HIV remains a persistent challenge in the US; roughly one in seven Americans living with HIV remain unaware of their infection, and California carries one of the nation’s highest HIV burdens. These are the same Californians who carry the highest risk of undiagnosed HIV, and an ED visit is often the one reliable moment when a test can reach them.
The ED is California’s safety net
Share of ED encounters by expected payer, 2024
Source: Department of Health Care Access and Information (HCAI), ED facility pivot profile, 2024.
California has begun to invest in this opportunity. In 2023, through the California Department of Public Health, the state launched the ED Syphilis/HIV/HCV Screening Program (EDSP), allocating more than $13 million to 28 California EDs. The state’s recently finalized budget commits an additional $60 million over the next six years to further support ED-based HIV, hepatitis C, and syphilis screening and linkage to care programs.
Underneath all of this is a need for more granular data. HIV in the US is reported at the county level. When estimating risk or disease burden in ED settings, county-level estimates are likely wrong in a particular direction. Although conservative, they underestimate the true burden among those seeking care in California EDs. Further, persons seeking ED care do not necessarily respect county lines. Even within a single county, individual EDs can serve unique populations with unique risk profiles.
For modeling efforts, for research, and for public health programs deciding where limited resources should go, this leaves a somewhat data-free zone. A place where better data could tell us where testing happens, where it finds HIV, and where the largest unmet needs sit. The California HIVer Project exists to close that gap, one ED at a time. Join us.