Something is definitely not quite right with the concept or delivery of Prevention of Mother-to-Child HIV Transmission (PMTCT) services. While uptake has been known to be poor, in spite of policy guidelines that require all expectant mothers seeking antenatal care to be counselled and offered an HIV test, it has now emerged that health workers are having to contend with a significant number of rural women who reject positive results. HEPS-Uganda has found worrying cases of expectant mothers who consent to an HIV test in Kamwenge in western Uganda turn around to decline positive tests. In a December 2007 project report titled, “Community Empowerment and Participation in Maternal Health in Kamwenge District”, HEPS-Uganda says that while its project resulted in more pregnant women seeking ANC services, a big proportion of them still refuse to consent to voluntary HIV counselling and testing (VCT) services and that some of the few who consent do not accept their results. HEPS-Uganda’s project was implemented using the Participatory Reflection and Action (PRA) methodology, in which communities participate in researching into their problems as well as in trying to solve them. The project aimed at increasing demand for, access to and utilisation of maternal health services by expectant mothers in Kamwenge Sub-county, Kamwenge District. The project was funded by the Regional Network on Equity in Health in East and Southern Africa (EQUINET). The participatory project involved health workers and community members, including community leaders, expectant mothers, male spouses, and others in the sub-county. The HEPS-Uganda project team facilitated the community to identify and try to solve barriers to use of maternal health services. The key barriers identified include: 1) expectant mothers don’t deliver at hospital; 2) bad attitude of health workers toward pregnant women; and 3) husbands do not give adequate support to their wives during pregnancy. Interventions to reduce the key barriers centred on a sensitisation campaign targeting health workers, expectant mothers and their husbands, and community members; and implementation of a feedback mechanism based on suggestion boxes at health units. While a comparison of the status before and after the intervention suggested that maternal health problems remained high and many barriers to access services persisted, positive change was perceived in ease of access to and affordability of services, in communication between community and health workers and the respect shown by health workers, in the support given by health workers and families, and in awareness and action on maternal health in the community. Even then, however, the uptake of PMTCT services remains a challenge. The first stage of exclusion has been because the services are provided through formal health facilities, where only a small proportion of pregnant women seek services. The second stage is where the pregnant women still have the right to decide whether to test for HIV, and many continue to decline the test. Now the third stage seems to have emerged, where some of the already few women who consent to an HIV test reject the results if they are positive. When a policy fails at so many stages, something is definitely wrong with its concept or in the way it is implemented. But at the stage where results are rejected, accusing finger should be directed at the quality of counseling. The Ministry of Health needs to strengthen the standard of counseling at all PMTCT centres and take the programme to the community if the number of children catching HIV from their mothers is to reduce.