In Africa, a large proportion of HIV infections occur within stable relationships, either because of prior infection of one of the partners or because of infidelity. Hence, there is an urgent need to define strategies to improve HIV prevention in a conjugal context. HIV counselling and testing have largely been organised within individual and sex-specific services such as prevention of mother-to-child transmission of HIV programs for women, or STI consultations for men. This does not facilitate the communication around the HIV status of each couple member and the adoption of preventive behaviours within the couple. One of the potential strategies is a couple-centred approach to HIV counselling and testing. In this paper, we first describe the stakes of HIV prevention within serodiscordant heterosexual couples in sub-Saharan Africa. We then systematically reviewed all couple-centred initiatives for HIV counselling and testing that have been evaluated in the scientific literature since the early nineties. It appears that despite positive results, such couple-oriented programs have not been implemented at a large scale. In order to further stimulate and strengthen HIV prevention efforts, renewed and increased attention is urgently required to identify and promote adequate prevention messages and programmes to improve HIV prevention behaviours in conjugal contexts.