Government spending is a vital component of public finance that enables government to deliver services and implement policies of the executive. This research examines government spending for HIV/AIDS treatment at the provincial sphere of government and queries whether citizens can influence public policy decision-making for HIV/AIDS treatment. The research considers the nature of the state, it being either a unitary system or a federal system - centralised or decentralised. Importantly, the research examines the effect of citizen constituents on public policy decision-making, as they exercise their franchise to vote. In other words, the research empirically examines how government has spent in response to the HIV/AIDS epidemic and measures any influence voters may have on government spending.