INTRODUCTION:
south africa's hiv epidemic is undergoing a demographic shift driven by increased life expectancy among people living with hiv (plhiv), resulting in a growing dual burden of hiv and non-communicable diseases (ncds). this study investigates the prevalence of ncds, medication coverage, and hiv care continuum among adults with and without ncds.

METHODS:
data from the sixth south african national hiv prevalence, incidence, and behaviour survey (sabssm vi) were analysed. participants aged ≥15 years completed questionnaires and provided blood samples for hiv testing, antiretroviral metabolite detection, and viral load measurement. ncd diagnosis and medication were self-reported. viral load suppression (vls) was defined as hiv viral load <1000 copies/ml. descriptive statistical analysis with survey weights was conducted.

RESULTS:
of 34378 participants, 19.0% reported a current ncd diagnosis, representing 8.5 million adults (≥15 years) in south africa. among these, 90.9% (7.2 million) were receiving ncd medication. hypertension (14.9%; 6.6 million), diabetes (5.4%; 2.4 million) and moderate to severe asthma (2.1%; 0.9 million) were most prevalent. among plhiv, 15.7% reported an ncd diagnosis (1.15 million), with 91.7% (1.0 million) receiving ncd medication. hypertension (12.4%; 903218) was most prevalent among plhiv. population vls was 87.0% among plhiv with ncds and 81.2% among those without. plhiv aged 45 years and older with ncds, those aged 25–34 years with ncds, and both females and males with ncds achieved the global 95–95–95 targets.

CONCLUSIONS:
approximately one in five south african adults and one in six plhiv reported ncd diagnosis, with most receiving medication. the aging hiv epidemic is linked to a growing burden of multimorbidity, signaling the need for integrated service delivery models that align ncd and hiv care to optimise health outcomes.