HIV rates continue to increase among heterosexual couples in many countries including Uganda. This article examines approaches to antenatal care and heterosexual partners’ HIV testing in Amuru subcounty, northern Uganda, drawing on findings derived from fieldwork and interviews. The study findings reveal how institutional structures influence the uptake of HIV testing amid power dynamics, wherein many male partners refuse to be tested. Discussed are the coercive approaches to HIV testing in which couples’ participation in HIV testing is leveraged by connecting testing to future maternity care. This article advances understandings about how heterosexual gender relations at the local, regional, and global levels affect the health of women, men, and families in Amuru subcounty.