Nigeria, Aug. 20 -- Grace* never saw a state budget document, she never read a federal appropriation law or examined a budget implementation report.

She probably did not know that Nigeria's HIV response was financed largely by international donors, or that governments at both the federal and state levels had, for years, pledged to assume greater responsibility for sustaining the programmes that kept people like her alive.

What she knew was simple: the community health worker who discreetly delivered her antiretroviral medicines stopped coming, the counselling sessions ended, and the confidential support that allowed her to avoid the crushing weight of stigma vanished.

Forced to collect her medication at a public treatment centre, Grace...