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The prevention of mother-to-child transmission of HIV is a public health priority worldwide. This biomedical intervention raises socio-cultural issues related to HIV infection and couple relationships. Yet little attention has been paid to the involvement of men within the prevention of mother-to-child transmission of HIV. This paper first reviews the literature on the involvement of men within the prevention of mother-to-child transmission of HIV in resource-limited countries, and then presents the results of a crosssectional and qualitative study conducted in the context of an HIV intervention trial in four resource-limited countries.The influence of men on the acceptability and use of prevention of mother-to-child transmission of HIV services is significant. However,the role given to and played by men within these services is limited. This lack of involvement may be explained by the conceptual and structural definition of the prevention of mother-to-child transmission of HIV, focused on mothers and infants, by the lack of communication within the couple and by the social constructions of the role of men within reproductive health. It is urgent to document and implement a new approach to the prevention of mother-to-child transmission of HIV, and to overall HIV prevention and care, which is oriented towards the couple.