Understanding barriers to HIV testing during pregnancy among women who attended ANC in Soweto, Johannesburg: a socio-ecological perspective.

Vertical transmission of HIV remains a significant challenge to maternal and child health in high burden settings. Early identification of maternal HIV status enables timely antiretroviral therapy initiation and helps prevent transmission during pregnancy, childbirth, and breastfeeding. This study explored barriers to HIV testing uptake among pregnant and postpartum women attending antenatal care (ANC) services in Soweto, Johannesburg. A qualitative research design was employed, involving in-depth interviews with ten adult women who accessed ANC services. Data were analysed thematically using Atlas.ti 23 software. Findings revealed multilevel barriers across the socio-ecological spectrum. At the individual level, fear of HIV testing and its potential outcomes discouraged uptake. Interpersonal factors, particularly partner and family influences, shaped women's testing decisions. Institutional barriers included negative healthcare providers attitudes, inadequate privacy, and insufficient counselling. At the community level, stigma amd discrimination discouraged HIV testing, while systematic barriers included gaps in implementing and enforcing HIV testing policies. These findings highlight the need for intergrated interventions addressing individual, interpersonal, community, institutional and systemic barriers. Strengthening confidentiality, improving healthcare provider communications, reducing stigma and enhancing policy implementation may improve HIV testing uptake among pregnant and postpartum women and streghthen maternal HIV prevention services.