Background: The vertical transmission of HIV from mother to child ranges from 15 to 40%. The preventing mothers to child transmission programme (PMTCT) services have been introduced during the past five years in South Africa; however vertical transmission of HIV remains high. Objectives: The objectives of the study were: 1. To describe the clinical and demographic characteristics of women attending the ANC clinic and delivering at the Germiston Hospital; 2. To determine the proportion of women who were offered voluntary counselling and testing (VCT) in 2004; 3. To determine the proportion of women who subsequently received PMTCT. Methods: This is a cross-sectional study I which a sample of 776 patient files were retrospectively, systematically and randomly sampled from 1, 500 antenatal files for the period 2004 (Jan-Dec), in an urban district hospital in the Gauteng Province. A checklist was used to extract specific information. Data was entered into EpiData and analysed using STATA version 8. Pearson's chi-square test was used to obtain measures of association for all categorical variables. The multiple logistic regression method was used to investigate predictors for missed PMTCT opportunities. Results: The pre_yalence proportion of syphilis was 14.19% {95%CI (11.81-16.85)}; prevalence proportion ofHIV was 33.76% {95% CI (27.53-37.13)}. The mean age ofthe sample population was 26.37 years (min=22, max=30). Forty eight per cent of the sample had registered late in the third trimester of pregnancy. Pregnant women presenting with syphilis were more likely to have a missed PMTCT opportunity {OR=2.2, 95%CI (1.16- 4.20), p=0.02}. Women having made fewer than two ANC visits were more likely to have a missed PMTCT/VCT opportunity than women having made more than two visits {OR=O.Sl, 95%CI (0.30-0.86), p=O.Ol}. Conclusions: The prevalence proportion of HIV is high in this setting (33%) and the prevalence of syphilis is seven times greater than the national prevalence. Every antenatal care visit is an opportunity for the healthcare worker to offer voluntary counselling and testing. All women identified as having syphilis infection are at high risk of acquiring HIV. Therefore every woman identified and treated for syphilis should be counselled and tested for HIV. Women must be offered HIV and AIDS education at every ANC visit. Routine opt-out counselling should be offered at every ANC visit for those who have not been previously tested. Recommendation: In order to increase the uptake of the PMTCT programme healthcare workers should have training and re-orientation on: 1. The need to use every opportunity in antenatal care and maternity wards to offer HIV counselling and testing to mothers; 2. HIV and AIDS in pregnancy, PMTCT, as well as the treatment and care of pregnant women. / Dissertation (MPH)--University of Pretoria, 2006. / School of Health Systems and Public Health (SHSPH) / MPH / Unrestricted