For more than thirty years, the HIV pandemic has caused immense harm across sub-Saharan Africa. From the middle of the last decade, however, a treatment revolution has been underway, as effective antiretroviral drugs (ARVs) have become available to millions of ordinary people. This thesis examines the far-reaching consequences of this new reality in Northern Nigeria. It argues that the significance of the ARV era cannot be fully understood simply by monitoring how many patients are receiving treatment, but instead must be explained in terms of the multifaceted changes it has driven in institutions and the lives of HIV positive people. This study uses ethnographic case studies and participatory methods to understand this new historical moment from ‘below’. It provides new empirical perspectives on how the ARV era has profoundly altered the ways in which HIV positive people suffer. The difficulties of daily life when subjected to opportunistic infections, side effects from drugs, and social stigma are compounded by memories of past trauma and fears for an uncertain future. Previous studies have indicated HIV positive people often form new relationships (e.g. Rhine, 2009), but rarely have these post-HIV relationships been described. This study argues that these new relationships, often distant from conventional family supervision, have a unique character, blending traditional forms with ‘modern’ ideas about romance. After a HIV disclosure, incomes and assets (particularly those reliant on family relationships) are often reduced. Along with the cost of treatment (broadly defined to include a range of curative practices), this forces those living with HIV to adapt their livelihood strategies, often using networks of solidarity between positive people. The process of lobbying for improvements in medical care is also explored. Both doctors and NGOs advocate on behalf of HIV positive people, but do so with strikingly different tactics and results. This has important implications for continuing debates about working ‘with the grain’ (Crook and Booth, 2011) for development in patrimonial states. In summary, whilst HIV treatment has saved the lives of millions, inventing drugs and getting them to the people who need them are merely the first steps in alleviating suffering. The thesis traces the most important tasks in securing wellbeing in the ARV era – those pursued by HIV positive people themselves.