  Let $H$ be a strongly irreducible Heegaard surface in a closed oriented
Riemannian $3$-manifold. We prove that $H$ is either isotopic to a minimal
surface of index at most one or isotopic to the boundary of a tubular
neighborhood about a non-orientable minimal surface with a vertical handle
attached. This confirms a long-standing conjecture of J. Pitts and J.H.
Rubinstein. In the case of positive scalar curvature, we show for spherical
space forms not diffeomorphic to $\mathbb{S}^3$ or $\mathbb{RP}^3$ that any
strongly irreducible Heegaard splitting is isotopic to a minimal surface, and
that there is a minimal Heegaard splitting of area less than $4\pi$ if $R\geq
6$.
