Abstract Over the last decade evidence has emerged suggesting that fisherfolk, as an occupational group, are at greater risk to human immunodeficiency virus (HIV) than other groups in many countries, including Uganda. In this paper we argue that the organization of work in fisheries on Lake Victoria, both now and in the past, encourages patterns of sexual behavior among men and women involved in fishing, trading, and servicing the industry which over the last 20 years has promoted the spread of the HIV among those working in fisheries. We use a case study of a family, Kiwanuka's, to illustrate how patterns of behavior practiced in the past (by Kiwanuka) have much more disastrous consequences now (for his children) because of the existence of HIV. Kiwanuka was a fisherman on Lake Victoria during the 1960s. During that time fish were plentiful and he earned enough to purchase land and establish himself as a coffee farmer. Two of his sons are currently employed as daily laborers at the lake. They complain of poor fish catches and their inability to make money. One daughter, who is HIV‐positive, is a dried fish trader. This family's experience illustrates the far‐reaching effects of economic and health conditions generated by the fishing industry on distant rural areas and across generations. Rising HIV rates are severely affecting fishers and related occupations already hit by falling fish stocks. The findings show how the same patterns of sexual behavior and wealth generation practiced by the older generation in their youth now represent a deadly risk to their children, a population in urgent need of better access to treatment, prevention, and care.