We conducted a large population-based survey among adults measuring weight, height, and blood pressure nested within an HIV survey in rural KwaZulu-Natal, South Africa, to identify and characterize clusters of overweight and hypertension in a typical rural African population and to explore whether geographic clusters can be accounted for by established individual-level risk factors. 58.4% of the participants were overweight and 22.6% were hypertensive. One cluster of high prevalence of overweight (RR=1.50, p<0.001) was identified using Kulldorff spatial scan statistic as the most likely cluster, whereas a low-risk cluster was identified in the nearby high-density settlement area (RR=0.62, p<0.05). No geographic clusters of hypertension were identified. After controlling for age, sex, educational attainment, household wealth, marital status, place of residence, and HIV status, no spatial clustering of overweight remained. The results provided clear evidence for the localized clustering of overweight. Identification of clustering of chronic disease could provide additional insights into the prevention and control for the rural South African population.