Abstract: The roll-out of antiretroviral therapy (ART), an HIV treatment, since 2000 has been found to dramatically improve HIV survival and increase adult life expectancy. We exploit the roll-out of ART in rural Malawi and provide national-level evidence on the effects of ART on an extensive array of health and economic outcomes. Combining a nationally representative survey data set with administrative data from Malawi’s Ministry of Health on health clinics, we construct a spatial and temporal variation in ART availability and estimate a difference-in-difference model. We find that access to the life-saving therapy significantly reduced illness-related prime-age mortality and morbidity. ART roll-out explains 60 per cent of the total decline in illness-related prime-age mortality observed in our data between 2004 and 2016. This improved health is accompanied by a significant increase in the work time of casual labour by 22 per cent but not in other activities, such as agriculture. This increase in work time did not change income, total expenditure and assets owned. Despite the null effects on economic well-being, we detect substantial effects on household expenditure on health and education. Our findings suggest that ART availability may have created surplus labour in a mainly rural economy like Malawi so that increased ability to work and human capital investments did not translate into improved economic well-being.