Twin epidemics: the effects of HIV and systolic blood pressure on mortality risk in rural South Africa 2010-2019
Demographic and Health Surveillance System
This dataset includes the "HIVafter40" data file which is the basis for the research publication Twin epidemics: the effects of HIV and systolic blood pressure on mortality risk in rural South Africa, 2010-2019.
The HIVafter40_Twin_Epidemics_HIV_NCD data was created as part of the HIVafter40 project, the successor to the Ha Nakekela Project, both nested within the Agincourt Health and socio-Demographic System (AHDSS) located in Northeastern South Africa.The projects use mixed methods to measure prevalence and incidence of HIV and NCDs, investigate health and sexual behaviours, and study how people have coped with the abrupt introduction of a new and deadly health threat and efforts to prevent and ameliorate it. The overall goal of HIVafter40 is to examine life course and contextual variation in HIV risk and protective behaviors and mortality in a rural sub-Saharan African population.
The AHDSS has, since 1992, collected an annual census from households in a defined geographic area of Mpumalanga Province. The 2009 census served as the sampling frame for the 2011 Ha Nakekela Project. The AHDSS provides rapid measures of vital statistics and is the basis of a wide range of more detailed studies. As of June 2018, the study site consisted of 31 villages with a population of 116,549 people, living in 22,721 households. Further information is available at <https://www.agincourt.co.za/> and specifically for census data collection, at <https://www.agincourt.co.za/?page_id=1805>
The Ha Nakekela project undertook two data collection efforts:
1. The Ha Nakekela Survey
This survey is based on an age/sex stratified sample of respondents in the 2009 AHDSS Census. Carried out in 2010-11, the cross-sectional survey included 5,080 respondents, of whom 2,080 are aged 40 - 93. It has 3 parts:
Behavioral Risk Assessment (based on BERIS Sexual Behavior Questionnaire)
Chronic Disease Risk Factor Surveillance (based on STEPS Health Risk Questionnaire)
HIV and Non-Communicable Disease (NCD) biometric data
2. The Izindaba za Badala (Matters that Concern Older People)
This Study (IZB) is nested within the Ha Nakekela Survey. It consisted of three related interview studies carried out in 2013:
IZB Life History Interviews: 60 life history interviews with people with and without HIV aged 40-84 who participated in the Ha Nakekela Survey
IZB Community Focus Group Interviews: 9 community focus group interviews with a total of 77 respondents
IZB Key informant Interviews: 9 health workers interviews in 3 local health clinics
The HIVafter40 project added two follow-up data files:
This data file contains information on the Ha Nakekela sample in which individuals were linked to their location/outcome reports in successive AHDSS censuses through 2020. This dataset permits examination of mortality in the nine years subsequent to participation in the Ha Nakekela Survey. HIVafter40_Twin_Epidemics_HIV_NCD.dta is a subset of this dataset.
b. Izindaba za Badala Round 2
IZB Life History Interviews: 25 in-depth follow-up interviews in 2018
IZB Community Focus Group Interviews: 10 community focus group interviews with a total of 84 participants in 2018
IZB Key informant Interviews (cancelled due to the COVID-19 epidemic):10 community focus group interviews with a total of 84 participants planned for 2020.
The website https://hivafter40.princeton.edu/ is regularly updated and contains the most complete information on the projects.
Kind of Data
Unit of Analysis
v1. Edited, anonymised data for public distribution
The projects measured prevalence and incidence of HIV and NCDs, and investigated health and sexual behaviours, as well as how people have coped with the abrupt introduction of a new and deadly health threat and efforts to prevent and ameliorate it. The Ha Nakekela Survey collected Behavioral Risk Assessment data (based on BERIS Sexual Behavior Questionnaire), Chronic Disease Risk Factors (based on STEPS Health Risk Questionnaire), and biometric data on HIV and Non-Communicable Diseases (NCD)
The study was conducted in the Agincourt Health and socio-Demographic System (AHDSS) site located in Mpumulanga Province, Northeastern South Africa.
The data is at the level of Village.
Producers and sponsors
Ohio State University
F. Xavier Gómez-Olivé
University of the Witwatersrand
Australian National University
Chodziwadziwa Kabudula Whiteson
University of the Witwatersrand
University of Colorado Boulder
University of Missouri
University of Oxford
University of Colorado Boulder
University of Maryland, College Park
University of Michigan
National Institute on Aging
University of Colorado Boulder Innovative Seed Grant
William and Flora Hewlett Foundation
SPARC Fellowship, Wits
Dates of Data Collection
Data Collection Mode
Oversight and Ethics Approval
HIVafter40/Ha Nakekela received IRB approvals from the University of Colorado Boulder, the University of Michigan, Princeton University, the University of the Witwatersrand Human Research Ethics Committee, and the Department of Health, Mpumalanga Provincial Government, South Africa.
Data Collection Notes
The projects used mixed methods which are discussed in the supporting documentation. Data was collected face-to-face with questionnaires and in focus groups.
Data was collected using an Interview Schedule for individuals, one for Key Informants, and one for Focus Groups. The BERIS Sexual Behavior Questionnaire and the World Health Organisation's STEPS Health Risk Questionnaire informed the data collection.
Data collection instruments are provided with the data files and can also be downloaded from https://hivafter40.princeton.edu/study-instruments
University of Cape Town
Public access data for use under a Creative Commons CC-BY (Attribution-only) License
Houle, B. et al. Twin epidemics: the effects of HIV and systolic blood pressure on mortality risk in rural South Africa, 2010-2019 [dataset]. Version 1. Agincourt: HIVafter40 and Ha Nakekela (We Care) Projects [producers], 2022. Cape Town: DataFirst [distributor], 2022. DOI: https://doi.org/10.25828/vr0p-ch08