INTRODUCTION:
vertical transmission of Human Immunodeficiency Virus (HIV) remains a significant challenge to achieving optimal maternal and child health outcomes in high-burden settings. early identification of maternal hiv status is critical for the timely initiation of antiretroviral therapy and the prevention of hiv transmission during pregnancy, childbirth, and breastfeeding. this study explored barriers to hiv testing uptake among pregnant women and recently postpartum women attending Antenatal Care (ANC) services in soweto, johannesburg.

METHODS:
a qualitative research design was employed, using in-depth interviews with ten adult women who had accessed anc services. data were thematically analysed using atlas.ti version 23 software.

RESULTS:
the findings revealed multi-level barriers to hiv testing uptake across the socio-ecological spectrum. at the individual level, fear related to hiv testing and potential outcomes discouraged participation. interpersonal factors, particularly influences from partners and family members, significantly shaped decision-making. institutional barriers included negative attitudes from healthcare providers, inadequate privacy, and insufficient counselling. at the community level, hiv-related stigma and discrimination persisted as major deterrents, while systemic barriers included gaps in the enforcement of hiv testing policies.

CONCLUSIONS:
the study highlights the urgent need for integrated interventions that address structural, social, and individual-level barriers to improve hiv testing uptake among women attending anc. these findings provide critical insights for policymakers and healthcare providers to strengthen maternal hiv prevention strategies and enhance the delivery of anc services.