© 2019, © 2019 Taylor & Francis Group, LLC. This study examined the impact of fetal or infant loss on HIV care engagement. We conducted semistructured interviews with 15 HIV-infected women who experienced fetal or infant loss while enrolled in prevention of mother-to-child transmission (PMTCT) services in Tanzania. Women attributed the loss to delays in receiving health care. Provider communication about the cause of the loss was poor, and women reported substantial distress related to the loss. One fifth reported gaps in HIV care or disengagement from care following their loss. Loss of a fetus or infant is not uncommon in HIV endemic settings, and should be integrated into PMTCT guidelines.