ABSTRACTRationale of the Study: The Gambia is a developing country and the majority of the population are women. They need adequate support, information and knowledge to protect themselves from acquiring HIV, and for those already infected from transmitting it to their infants either during pregnancy, delivery or breastfeeding. The Gambia has a low prevalence of HIV, but despite that the number infected increased yearly among women of childbearing age and among children. The rates of mother-to-child transmission for HIV-1 and HIV-2 were estimated at 25% and 4% respectively in a cohort study of antenatal mothers between 1993 and 1995. In a follow-up study in 2002, 34% of the mothers identified in 1993 to 1995 had died; 69% of HIV-1 infected children also died.In light of this, the Department of State for Health has decided to integrate Voluntary Counselling and Testing in certain antenatal clinics with free antiretroviral drugs, and for women, the need to know their status is paramount. Many studies on HIV/AIDS have been conducted in the Gambia, but none have specifically investigated factors that influence acceptability of VCT among pregnant women. Little is also known about what women know about HIV/AIDS and their perception of risk.Objectives: The main objective of this study was to explore and describe factors that influence acceptability of voluntary HIV counselling and testing among pregnant women in Western Health Division of the Gambia.Materials and methods: A cross-sectional study was conducted among pregnant women in western health division of the Gambia. A quantitative methodology with the aid of a structured questionnaire was used to collect the data. The study design was facility-based and, pregnant women were invited to participate when they came to the antenatal clinics included in the study. Midwives were instructed to invite women of all ages, educational levels, parity and occupation in a convenience-based sample. A total of 246 pregnant women were approached and asked to participate in the interview, out of whom 229 actually participated; (a participation rate of 93%)Results: The majority of pregnant women (65%) and (51%) had high knowledge on the modes of HIV transmission and on MTCT of HIV respectively. There was a significant difference in level of knowledge on HIV spread between educational groups. Women with formal education seemed to be more knowledgeable than those with no formal education (x2 = 6.09, df = 1, p = 0.01). Nearly half of the women had low knowledge on specific areas of MTCT such as the transmission of the virus through pregnancy, delivery and breastfeeding. The majority of pregnant women (61%) also had low knowledge on the three basic prevention messages (ABC) of HIV. Some misconceptions relating HIV transmission were also reported in the study and the majority of the pregnant women (55%) perceived themselves as not susceptible to HIV /AIDS. Nearly all the women, (98%) were aware of the existence of the PMTCT programme. The majority (92%) had gone through the pre-test counselling, but 82% have actually done an HIV test of which 72% had taken the decision independently. Return rates were also found to be very high (91%). The need to know ones serostatus; and if HIV positive, be offered ARVs to protect the child and to prolong own life were factors that motivated or influenced women to accept HIV testing. The majority of the respondents (97%) would like to notify their partners about an HIV seropositve result and two third preferred to seek VCT together as a couple. Neighbours and other community members would never be informed of an HIV positive result and 80% of the respondents would not discuss their HIV serostatus openly if they were positive.Conclusion: The findings from this study showed that women easily accepted VCT and return rates were equally high. There is an indication that women’s acceptance of HIV test seemed to depend on their view that going through the VCT process and the provision of and access to antiretroviral drugs provide benefit for both the child and themselves. We therefore believed that improving the accessibility and affordability of ARVs to HIV positive individuals, and encouraging couple counselling could significantly increase the up take of the VCT services in the Gambia.Key words: Couple Counselling, HIV Testing, PMTCT Programme, Level of knowledge, Informed Consent, Pregnancy.