Exposure to human immunodeficiency virus (HIV) is a recognized occupational hazard to healthcare personnel. The virus also presents an operational hazard to deployed Special Operations Forces (SOF) personnel. Management guidelines for work related exposure to HIV mainly deal with healthcare workers in a first world hospital environment. Formal guidelines for postexposure prophylaxis (PEP) regarding potential HIV exposure in third world environments have not been established. SOF personnel deploy to regions such as sub-Saharan Africa with a reported HIV prevalence of 35% or higher. This article examines the case of a SOF servicemember exposed to HIV in a confrontation with host nation personnel, the problems with trying to utilize current CDC guidelines and host-nation healthcare capabilities, and a proposed solution devised to ensure appropriate PEP in future cases.