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This paper aims at quantifying the effect of healthcare programs on macroeconomic outcomes in developing countries experiencing epidemiological transitions. It is widely accepted in the literature that programs focusing on access to care result in productivity gains among workers in poor health. However, these programs have the additional effect of modifying both the size and the composition of the workforce by increasing the proportion of individuals suffering from chronic illnesses, thus mitigating the effect on average productivity. First, we define the theoretical conditions under which this macro-epidemiological phenomenon outweighs the positive effect on production of improved access to care. Second, we decompose the economic consequences of access to antiretroviral treatments for HIV/AIDS in three sub-Saharan African countries. Forecasts of an individual’s health status and production, depending on whether he or she has access to medication, are generated using a microsimulation model. We use the model to generate a counterfactual (as if the adverse epidemiological effect did not exist), which makes it possible to decompose the total impact of the HIV-medication program into two different effects: positive and negative. We find that the positive productive effect of treatment procurement outweighs the negative epidemiological effect. Of course, this approach is only an indicator of economic performance and should in no way constitute a decision-making criterion about the ethical necessity of access to health care. JEL codes: I15, J11, J21