Background: Botswana is regarded as a leader of progressive HIV/AIDS policy, as the first country in sub-Saharan Africa to establish a free, national antiretroviral therapy program. In light of such programmatic successes, it is important to evaluate the potentially changing relationship of HIV/AIDS to the wellbeing of individuals, households, and institutions in the country. Methods: We evaluate the effects of HIV-related illness on absenteeism and earnings several years after the start of the national treatment program among a random sample of adults in Botswana using survey data from 3999 individuals aged 15 to 49, using quasi-experimental methods. We compare absenteeism between individuals with and without HIV-related illness, using a propensity score matching approach. We then estimate the effect of HIV-related illness on earnings using a Heckman selection model to account for selection into the workforce. We stratify our analyses by sex. Results: Men and women with HIV-related illness were absent by about 5.2 and 3.3 additional days, respectively, in the month prior to the survey compared to matched controls, and earned approximately 38% and 43% less, respectively, in the month prior to the survey compared to those without HIV-related illness. Conclusions: HIV-related illness appears to increase absenteeism in this sample and dramatically reduce earnings. The findings suggest a need for policies that confer greater financial security to individuals with HIV/AIDS in Botswana.