The Antenatal HIV Sentinel Survey (ANCHSS) has been conducted in South Africa since 1990, annually between 1990 and 2015 and biennially since 2015, with the main aim of monitoring HIV epidemic trends among 15 to 49-year-old pregnant women attending antenatal clinics. The 2019 survey was the 28th survey conducted in South Africa. The objectives of the 2019 survey were: to estimate HIV prevalence and the geographic distribution of HIV, knowledge of HIV status, and coverage of antiretroviral therapy (ART) among pregnant women attending antenatal care (ANC) in selected public health facilities from across all districts of South Africa, and to estimate the coverage of maternal syphilis screening and treatment, the prevalence of unintended pregnancy, and early attendance of ANC. HIV prevalence among pregnant women has remained largely unchanged at around 30 per cent since 2004. The consistent decline in HIV prevalence among young women (15 to 24 years) is encouraging as this age group experiences a high rate of HIV incidence (1.5 per cent) compared to their male counterparts (0.5 per cent). The high PMTCT ART coverage regardless of age group shows the success of the PMTCT programme. Promising progress has been observed in the number of HIV-positive women initiating ART before pregnancy, although young women (15 to 24 years) were still less likely to know their HIV-positive status before pregnancy compared to older women (>35 years).