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This document responds to growing need at country level for basic operational guidance on provider-initiated HIV testing and counseling in health facilities. It is intended for a wide audience including policy-makers, HIV/AIDS program planners and coordinators, health-care providers, non-governmental organizations providing HIV/AIDS services and civil society groups.

Evidence from both industrialized and resource-constrained settings suggests that many opportunities to diagnose and counsel individuals at health facilities are being missed and that provider-initiated HIV testing and counselling facilitates diagnosis and access to HIV-related services. With this approach, an HIV test is recommended 1) for all patients, irrespective of epidemic setting, whose clinical presentation might result from underlying HIV infection; 2) as a standard part of medical care for all patients attending health facilities in generalized HIV epidemics; and 3) more selectively in concentrated and low-level epidemics. Individuals must specifically decline the HIV test if they do not want it to be performed. Additional discussion of the right to decline HIV testing, of the risks and benefits of HIV testing and disclosure, and about social support available may be required for groups especially vulnerable to adverse consequences upon disclosure of an HIV test result.

Guidance on provider-initiated HIV testing and counselling in this document is categorized according to the following HIV epidemic types: low-level HIV epidemics, concentrated HIV epidemics, generalized HIV epidemics. This document also includes discussion on an enabling environment, pre-test informaiton and informed consent, post-test counseling, the frequency of testing, HIV testing technologies, and programmatic considerations.