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People living with HIV/AIDS (PLWHA) are more likely to experience significant generalized anxiety symptoms compared to the general population, which require both pharmacological and psychological treatment. There is limited evidence on the specific facilitators and barriers to treatment-seeking behaviours for significant generalized anxiety symptoms among PLWHA in Kilimanjaro region. This study aims to determine facilitators and barriers to treatment-seeking behaviours for significant generalized anxiety symptoms among PLWHA in Kilimanjaro region. This exploratory pilot study employed a qualitative design to assess facilitators and barriers to treatment-seeking for generalized anxiety symptoms among PLWHA in Kilimanjaro region and used the Generalized Anxiety Disorder-7 (GAD-7) screener to identify significant generalized anxiety symptoms in adult PLWHA who were followed up for three months. Thematic framework analysis was employed to identify and interpret patterns in treatment-seeking behaviors. Among 348 PLWHA, only 8.6% (30 PLWHA) had screened positive for significant generalized anxiety symptoms. Among 30 with significant anxiety symptoms, 6 (20%) PLWHA attended mental health services, 15 (50%) PLWHA did not attend, and 9 (30%) PLWHA were lost to follow-up. Facilitators identified were having mental health awareness, support from family and friends, and having good customer service in mental health clinics. Economic burdens, few mental health services, and stigma were potential barriers to treatment seeking for significant generalized anxiety symptoms. Addressing both facilitators and barriers to treatment-seeking for significant generalized anxiety symptoms among PLWHA, including increasing awareness, reducing stigma, improving access to services, and providing strong social support, is essential for enhancing mental health care.