Background:- It has been well established that mother to child transmission (MTCT) accountsrnfor the majority of HIV infections in children below the age of 15 years in developing countries.rnHIV counseling and testing (HCT) is an important entry point for HIV prevention and for earlyrnaccess to treatment, care and support. Willingness for accepting HCT is the key component and arnstarting point of overall HIV prevention efforts and represents a critical opportunity forrnstemming the tide of the HIV epidemic. rnObjective:- The main objective of this study was to assess the willingness of antenatal carernclients for HIV counseling and testing in Asella governmental health institutions.rnMethods:- Institutional based cross sectional study was conducted on 321 pregnant womenrnattended antenatal care during the study period using interviewer administered, pre-tested,rnstructured questionnaire from March to April, 2012 in Asella governmental health institutions.rnData was collected by convenient sampling technique after ethical clearance was obtained fromrnthe concerned authorities and then entered in Epi-info and analyzed using SPSS software. rnResult:- A total of 321 pregnant women (response rate 100%) attended antenatal care in Asellarnhospital and Asella health center were included in the study. Among the studied womenrn291(90.7%) were willing for HCT, and 30 (9.3%) were not willing for HCT. The strongestrnassociation with willingness for HCT rested with parity, number of ANC visits and perceivedrnrisk of HIV. Primipara women were about 12 times more likely willing for HCT than nullipararnmothers (AOR=12.33, 95% CI=1.25,121.57), and also those who had 2 and above ANC visitsrnwere 9.6 times more likely willing for HCT than those who had only 1 ANC visit (AOR=9.64,rn95% CI=1.93,48.28). Women who were perceived themselves not at risk of acquiring HIV werernmore likely willing for HCT than those women who perceived themselves at risk (AOR=0.08,rn95% CI=0.01,0.41). rnConclusion and Recommendation: This study revealed high-level of awareness about HIV,rnHCT, MTCT and PMTCT of HIV among pregnant women attended ANC in the study areas.rnRelatively increased proportion of willingness for HCT was seen when compared to other studiesrnand it has to be encouraged more, since it is a cornerstone for PMTCT of HIV. Health educationrntargeted on pregnant women on HCT, MTCT and PMTCT of HIV using different resources andrnmale partner participation would have paramount importance and would be important factor tornscale up HCT acceptance more at all levels.