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Background: Sub-Saharan African settings are experiencing dual epidemics of HIV and hypertension. We investigate effects of each condition on mortality and examine whether HIV and hypertension interact in determining mortality., Methods: Data come from the 2010 Ha Nakekela population-based survey of individuals ages 40 and older (1,802 women; 1,107 men) nested in the Agincourt Health and socio-Demographic Surveillance System in rural South Africa, which provides mortality follow-up from population surveillance until mid-2019. Using discrete-time event history models stratified by sex, we assessed differential mortality risks according to baseline measures of HIV infection, HIV-1 RNA viral load, and systolic blood pressure., Results: During the 8-year follow-up period, mortality was high (477 deaths). Survey weighted estimates are that 37% of men (mortality rate 987.53/100,000, 95% CI: 986.26 to 988.79) and 25% of women (mortality rate 937.28/100,000, 95% CI: 899.7 to 974.88) died. Over a quarter of participants were living with HIV (PLWH) at baseline, over 50% of whom had unsuppressed viral loads. The share of the population with a systolic blood pressure of 140mm Hg or higher increased from 24% at ages 40-59 to 50% at ages 75-plus and was generally higher for those not living with HIV compared to PLWH. Men and women with unsuppressed viral load had elevated mortality risks (men: adjusted odds ratio (aOR) 3.23, 95% CI: 2.21 to 4.71, women: aOR 2.05, 95% CI: 1.27 to 3.30). There was a weak, non-linear relationship between systolic blood pressure and higher mortality risk. We found no significant interaction between systolic blood pressure and HIV status for either men or women (p>0.05)., Conclusions: Our results indicate that HIV and elevated blood pressure are acting as separate, non-interacting epidemics affecting high proportions of the older adult population. PLWH with unsuppressed viral load were at higher mortality risk compared to those uninfected. Systolic blood pressure was a mortality risk factor independent of HIV status. As antiretroviral therapy becomes more widespread, further longitudinal follow-up is needed to understand how the dynamics of increased longevity and multimorbidity among people living with both HIV and high blood pressure, as well as the emergence of COVID-19, may alter these patterns., (© 2022. The Author(s).)

This paper focuses on a neglected factor in literature on the HIV epidemic in sub-Saharan Africa: the role of the eco-social environment in shaping HIV risk. I argue that the changing ecological environment of Lake Victoria, Africa's largest freshwater lake, mapping onto a gendered economy, shaped fisherfolk's sexual relationships and sexual mixing patterns in ways that were consequential for their HIV risk. Specifically, I show how disrupted lake and fish ecology had an impact on fishermen's sexual, domestic and economic partnerships, as well as how it contributed to the "sex for fish" economy in Nyanza Province, Kenya. I also show the consequences of fishermen's relative wealth on transactional relationships with school girls and women in lakeside communities. The paper is based on ethnographic fieldwork over a seven month period among the Luo ethnic group, which has the highest HIV rates in Kenya. The study included 74 individual and focus group interviews in communities around Lake Victoria, as well as 20 key informant interviews. Additionally, literature reviews on fishing and sexual economies as well as on ecological research in Lake Victoria are employed. Exploring linkages between these literatures and fieldwork findings forms the basis of this paper. I argue that solely focusing on individual level HIV prevention strategies is limited without taking into account the eco-social context of individual sexual decision making., (Copyright © 2010 Elsevier Ltd. All rights reserved.)