Partner involvement has been deemed fundamental in prevention of mother to child transmission (PMTCT) programmes, but is difficult to achieve. This study aimed to explore acceptability of the PMTCT programme components and to identify structural and cultural challenges to male involvement. The study was conducted in rural and urban areas in northern Tanzania. The study found that routine testing for HIV of women at the antenatal clinic was highly acceptable and appreciated by men, while other programme components, notably partner testing, condom use and the infant feeding recommendations, were met with continued resistance. It concludes that deep-seated ideas about gender roles and hierarchy are major obstacles to male participation in the PMTCT programme. Empowering women remains a challenge. Empowering men to participate by creating a space within the PMTCT programme that is male friendly should be feasible and should be prioritized for the PMTCT programme to achieve its potential.