Consistent with the results of previous studies, the present findings indicate that a significant proportion of South African child rape survivors (40 percent) do not qualify for post-exposure prophylaxis (PEP) either because they refuse HIV testing at initial presentation (1.5 percent), test HIV positive at initial presentation (6.5 percent), or present more than 72 hours after the abuse (32 percent of respondents). These findings add to a growing body of literature which has documented extremely low rates of return for PEP followup. The reasons show that non-return is likely to be “multiple and complex,” including child related issues such as adverse drug reactions, caretaker issues such as a lack of understanding of the need for followup, and/or societal issues such as stigmatization. Children in South Africa face a high risk of being raped, with 40 percent of reported cases of rape and attempted rape involving children under the age of 18 years and with rape being the most prevalent reported crime against children. The aim of this research was to first, examine the proportion of respondents who meet the inclusion criteria for PEP in a sample of South African child rape survivors presenting for medico-legal assessment; second, to determine the extent of drug adherence in the study sample; and third, to determine the proportion of respondents who return for 3- and 6-month HIV testing. Tables, references