Background: HIV testing and counseling (HTC) plays a central role in specific prevention of mother-to-child transmission (PMTCT) interventions, as these interventions depend on the woman knowing her HIV status. Over ninety percent of HIV infection in children is acquired through mother-to-child transmission. Objectives: This study assessed pregnant women’s knowledge of HIV/AIDS, their awareness of HIV testing and counseling, and compared the uptake of HTC to the previously practiced voluntary counseling and testing (VCT) in a teaching hospital in northern Nigeria. Materials and Methods: A pre-tested, structured interview questionnaire was administered on a cross-section survey of 270 antenatal clients in Ahmadu Bello University Teaching Hospital (ABUTH), Nigeria. Information about knowledge of HIV/AIDS and attitude towards HTC was elicited among respondents. Results: Eighty-nine percent of respondents were aware of HIV/AIDS. The knowledge of route of disease transmission was high, with 87.4% and 81.1% of studyparticipants mentioning sexual activity and mother-to-child transmission, respectively. Majority of respondents (98.9%) were aware of HTC and approved of it (91.1%) while 7.8% declined and the remaining 1.1% were undecided. Fourteen percent of respondents didn’t approve of retesting in labour. Sixty-eight percent of respondents were aware of interventions to prevent mother-to-child transmission of HIV. Switching from VCT to HTC has dramatically improved the uptake of testing from 78.9% in 2006 to 91.1% in 2012. Conclusion: Routine HIV testing and counseling is more acceptable than voluntary counseling and testing among antenatal clients. Although the awareness and uptake of HTC were quite high among the antenatal clients, there is still a need to intensify health education and incorporate husbands into the counseling session when necessary to convince the remaining minority who are still ignorant of the benefits of HTC.