OBJECTIVE To assess the characteristics, treatment received, and adherence to antiretroviral prophylaxis among South African rape survivors. METHODS Record review of clients presenting to the Northdale Lifeline Rape Crisis Center between May 2003, and July 2004. METHODS Data on demographics, record of treatment received with antiretroviral prophylaxis, syndromic treatment for sexually transmitted infections, and emergency contraception were collected. Adherence to antiretroviral prophylaxis was defined by filling 4 weekly prescriptions for zidovudine and lamivudine. Results of follow-up HIV testing were recorded. RESULTS A total of 390 records were reviewed. Ninety-five percent of clients accepted HIV testing at presentation, and HIV seroprevalence at presentation was 35.6%. Of the 233 clients testing HIV-negative, 198 (85%) received antiretroviral prophylaxis, 57% of whom were assessed as adherent. Only 55 clients (27.1%) returned for HIV testing at 6 weeks; 1 woman seroconverted. CONCLUSIONS Postrape care is an important service provided to South African women, and strategies should be developed to improve adherence to antiretroviral prophylaxis and follow-up testing.