Background: Ethiopia is one of the countries hard-hit by HIV/AIDS. Amhara region has thernlargest proportion of HIV positive women, HIV positive live births and AIDS orphans. PMTCTrnprograms are starting to be launched in many health facilities of the country. Thus it is imperativernto study the utilization of the services by pregnant women to ensure programme effectiveness.rnObjectives: - The objective of this study was in general to determine the level of utilization ofrnPMTCT program in western Amhara region and specifically to determine the level of antenatalrnVCT service utilization, to examine factors influencing acceptance of voluntary HIV counselingrnby pregnant women; and to explore client preferences and suggestions on PMTCT programrnimplementation by which acceptance may be increased.rnMethodology: - A health facility based cross sectional survey was conducted using structuredrnquestionnaire among 452 pregnant women following antenatal care (ANC) at selected facilities ofrnwest Amhara region between April and June 2006. Four focus group discussions (among pregnantrnwomen not following ANC for the current pregnancy and spouses of pregnant women) and eightrnin-depth interviews (among traditional birth attendants and counselors) were conducted.rnResults: - Response rate was 98%. Three-hundred and four (67.3%) of the respondents had underrngone the process of voluntary counseling and testing for HIV. Two hundred eighty-nine (97.6%)rnof them were tested for HIV and 274 (94.8%) of those who were tested received the test result. Ofrnall the socio-demographic variables, education was positively associated with acceptance of ANCrncounseling (AOR (95% CI) for formal schooling Vs no formal schooling = 3.67 (1.56, 8.61))rnwhile being a rural women and being a farmer were associated with less likelihood of undergoingrnHIV counseling in ANC [AOR (95%C.I.)= 0.22 (0.14, 0.35) and 0.44 (0.22, 0.98] respectively).rnCorrect knowledge with respect to transmission of HIV during labor and that it can be preventedrnby chemotherapy were associated with higher likely hood of using PMTCT services. The mainrnbarriers for utilization of PMTCT services identified were incorrect perceptions regardingrnHIV/AIDS and stigma by husband, family and community.rnConclusion: Based on the findings Community based education and sensitization targeted tornwomen, increasing access of women to VCT, promoting PMTCT to all facilities caring forrnwomen in the catchments areas is recommendedrnKey words: Pregnant women, PMTCT, VCT, HIV/AIDS, ANC, Ethiopia