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Objective The aim of the study was to assess the psychometric properties of the Afaan Oromoo version of Generalised Anxiety Disorder-7 (GAD-7) scale among people living with HIV.Design A hospital-based cross-sectional study.Setting The study was conducted at a tertiary-level antiretroviral therapy clinic.Participants The study included 163 people living with HIV.Primary outcome measures The GAD-7 scale was evaluated against the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnostic criteria for GAD as the gold standard.Result A total of 163 participants were enrolled (response rate: 98.2%). The Afaan Oromoo GAD-7 demonstrated excellent internal consistency (Cronbach’s alpha=0.92). A cut-off score of ≥9 provided the optimal balance between sensitivity (89.19%) and specificity (85.75%), with an area under curve of 0.91, a positive predictive value of 64.7% and negative predictive value of 96.4%. Confirmatory factor analysis supported a one-factor structure.Conclusions The findings indicate that the Afaan Oromoo version of the GAD-7 is a valid and reliable tool for screening GAD among adults receiving HIV care. Routine use of the GAD-7 in antiretroviral therapy clinics is recommended to support early identification of anxiety symptoms.