We explored how strategies to promote male partner engagementinfluenced HIV care-seeking among men and women living with HIV. In-depth interviews were conducted with 25 health workers, 66 femaleservice users and 10 male partners in Ifakara (Tanzania), Karonga(Malawi) and uMkhanyakude (South Africa) to elicit experiences ofoffering, providing or receiving HIV care in the context of antenatal care.Data were coded inductively and analysed thematically. Participantsreported benefits of couple testing during antenatal care, includingfacilitated HIV status disclosure and mutual support for HIV care-seeking.However, unintended consequences included women attending withoutpartners, being refused or delayed access to antenatal services. Somewomen were required to obtain letters from village leaders to justify theabsence of their partners, again to delaying or disrupting care-seeking.When partners attended antenatal care, consultations were reportedlymore likely to focus on HIV testing, and less on antenatal or neonatalcare. Strategies to increase men’s attendance at HIV clinics with theirpartners can promote mutual support within couples for HIV careengagement, but may risk undermining engagement in pregnancy andHIV care for some women if over-stringently applied. Efforts are neededto address the underlying pervasive stigma associated with HIV care,both alone and as a couple.