Midwives are expected to meet the demands of their ever-expanding roles without having a voice to contribute to the decision-making process in developing the protocols to be followed in implementing HIV/AIDS testing and counselling. The aim of the current study was to describe nurse managers’ support to midwives in implementing HIV/AIDS testing and counselling within protocol at an antenatal clinic located in the Central Region of Cape Town, Western Cape, South Africa. The study followed a qualitative design to gain insight into midwives’ experiences in implementing HIV/AIDS testing and counselling at an antenatal clinic and how nurse managers support midwives in this regard. In-depth individual interviews were conducted with eight (n = 8) purposively sampled professional midwives to understand the implementation of HIV/AIDS testing and counselling within protocol from the midwives’ perspectives and field notes were taken. All the interviews were digitally recorded, transcribed verbatim and coded using the thematic approach. The study findings indicated that ongoing education, coaching and mentoring, and constructive feedback are all necessary support mechanisms for midwives to implement HIV/AIDS counselling for better client care outcomes. It was recommended that nurse managers should intensify their efforts in an antenatal clinic, supporting midwives with practice relevant information on HIV, to address the needs of pregnant women and the larger community. Well-informed competent midwives are needed to apply the latest protocols and trends in midwifery practices that will uplift the health status of pregnant women in the community.