Abstract
South Africa has the highest number of people living with HIV in the world. Despite this, many South Africans do not know their HIV status and uptake of voluntary counselling and testing (VCT) has been suboptimal. In clinical settings there are many missed opportunities for HIV diagnosis as most patients are not routinely offered HIV counselling and testing (HCT). Provider-initiated counselling and testing (PICT) has been introduced to ensure that HCT becomes the standard of care in all consultations with health providers. PICT promotes universal access to prevention, care and treatment services for all clients by increasing the utilisation and acceptance of HCT services. 
 
 This article outlines the rationale for PICT as well providing an overview of the implementation protocol that will equip health care providers with the knowledge required to integrate HCT into routine medical care.
Highlights
THE EPIDEMIOLOGY OF HIV According to the World Health Organization (WHO), in 2007 more than 33 million people were living with HIV/AIDS with at least 2.7 million new infections being transmitted annually.[1]
HIV-infected patients who consult their family practitioners are still being missed as opportunities to test are lost
Diagnosis improves health outcomes of those who are HIV positive, while ensuring that they are provided with information to reduce transmission
Summary
HIV testing by medical practitioners should only occur when the client or his or her legal surrogate, e.g. parent or guardian, has provided informed consent. The client must be provided with information that is understandable according to his or her language, disability and literacy. The client must understand the nature of the test and its consequences and understand the purpose of the exchange of information as being in the best interests of his or her own health, that of the partner, and in the case of a pregnant woman, the fetus or the infant being breastfed
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