Back ground Mother-to-child transmission (MTCT) is by far the largest source of HIV infectionrnin children below the age of 15 years. The virus may be transmitted during pregnancy child birthrnor breast feeding. Globally 2.7 million children under the age of 15 years have died of AIDSrnsince the beginning of the epidemics. Over 9 in 10 were infected by their mothers. For manyrnyears little was known about preventing transmission of HIV infection from mother to child.rnRecently however, many interventions are available to reduce mother to child transmission, suchrnas anti retroviral drug and avoidance of breast feeding. For women to take advantage of measuresrnto reduce transmission, they need to know their HIV status. Despite this fact many women are notrnwilling to take voluntary HIV counseling and testing.rnObjective The main objective of the study is to identify factors determining acceptance ofrnvoluntary HIV testing among pregnant women at army hospitals in Addis Ababa.rnMethod Unmatched case control study was conducted on 88 acceptors and 176 non-acceptors ofrnVCT using structured pretested questionnaire from December 2004 to January 2005, at armyrnhospitals in Addis Ababa.rnResults Among socio-demographic factors the odds of VCT acceptance was higher among betterrneducated, married, with higher income women and among women whose husbands live at home.rnWomen who had better knowledge of VCT and MTCT and women with at least two ANC visitrnhad significantly higher VCT acceptance than their counterparts.rnvirnAdjusted for socio-demographic and some reproductive characters tics VCT acceptance wasrnsignificantly associated with knowledge about MTCT (OR=7.34, 95% CI= 3.44, 15.67), previousrnVCT experience (OR= 2.51, 95% CI= 1.03, 6.17) and husbands residence ( at home) (OR= 4.97,rn95% CI = 2.15,11.46).rnConclusions and recommendationrnEducation of the mother, knowledge of MTCT and VCT and partner participation were importantrnfactors of VCT acceptance. Health education targeted on pregnant women on PMTCT and VCTrnwould have paramount importance using different sourcesrnKey words acceptance, HIV testing, pregnant women, antenatal care