The HIV epidemic continues to spread at an alarming rate, with over 14,000 new infections per day. While the epidemic is now spreading rapidly in some parts of Asia and Latin America and Caribbean, sub-Saharan Africa continues to bear the greatest burden of disease. HIV prevalence exceeds 30 percent among sexually active adults in some African cities, and AIDS is the leading cause of death in major cities within sub-Saharan Africa.

More than 90 percent of the estimated 42 million persons living with HIV/AIDS (PLHA) around the world live in resource constrained countries in Africa, Asia, Latin America and Caribbean. But despite the very high number of people already living with HIV/AIDS, it is estimated that less than 10 percent are aware they are infected, mainly because of the limited availability, access, and use of voluntary counseling and testing (VCT) for HIV. This fact greatly hinders efforts to respond to the AIDS epidemic, as people have to know if they are infected if they are to access services.

HIV VCT has long been a component of HIV prevention and care efforts among affected communities in developed countries, and is now increasingly being implemented in resource-constrained countries. In the presence of a high prevalence and growing awareness of HIV, several governments have included VCT services as a major component of their national HIV prevention and care programs.

Because of the recognized importance of HIV VCT in national AIDS control programs, HIV VCT services are in various stages of development in many resource-constrained countries. Where available (these services tend to be of limited quality and coverage) they are implemented
by nongovernmental organizations (NGOs) and some public and private health centers, clinics, and hospitals.