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Objective: To determine the uptake of current antenatal HIV testing, the prevalence of risk factors for HIV in pregnant women and the acceptability of the rapid point-of-care HIV test (RPOCT) among pregnant women and their midwives. Design: A retrospective review of 717 notes to determine current HIV screening practices and a cross-sectional survey using a self-completed questionnaire for pregnant women and midwives. Setting: The antenatal clinic (ANC) and postnatal wards (PNW) at a university teaching hospital in the West Midlands. Participants: 486 women attending the ANC or admitted to the PNW during a fortnight in May-June 2006. 72 midwives on the delivery ward completed a second questionnaire. Results: The questionnaire showed that 90.4% of those offered the standard HIV test accepted it, with 7.2% having at least one risk factor for HIV. Over half of the decliners perceived themselves as not at risk. 85.2% would accept the rapid test, including 35.6% of the decliners. 92.8% of midwives agreed/strongly agreed the RPOCT has a role on the delivery ward and 97.2% would be happy to offer the test with appropriate training and guidance. Conclusions: Midwives deem the RPOCT to be appropriate for a variety of perinatal settings. It is also acceptable to a clinically significant proportion of those who decline the standard test (21 of 59) and therefore has the potential to increase screening and detection rates. Hence, by allowing early diagnosis and the initiation of antenatal interventions, it could reduce the rate of mother-to-child transmission (MTCT) in the UK. [ABSTRACT FROM AUTHOR]