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People living with HIV (PLWH) are at increased risk of frailty, yet the role of sleep disturbances in this risk remains underexplored. In this cross-sectional study, we aimed to evaluate self-reported sleep quality in PLWH and relevance to frailty in a high HIV-prevalence setting within Africa. We enrolled 50 PLWH on suppressive antiretroviral therapy (age: 56.9 ± 4.4 years; 26 females) and 50 matched HIV-seronegative controls (age: 56.6 ± 4.3 years; 24 females) in Botswana. Sleep quality was scored subjectively as "good" or "poor" based on participants' responses to two self-reported sleep questions. The frailty index was constructed based on thirty-three health deficits related to body mass index, waist circumference, physical activity, emotional status, and fatigue, and scored ranging between 0 (no deficit present) and 1 (all deficits present). PLWH displayed a 2.88-fold increase in odds of having poor sleep than controls (95% CI: 1.22-6.79,  = 0.02). Having poor sleep was associated with increased frailty index in PLWH but not in controls. Specifically, compared with PLWH who had good sleep, PLWH who reported poor sleep had a 0.15 (95% CI: 0.09-0.21,  < 0.0001) increase in their frailty index. These findings highlight the importance of sleep health in understanding frailty risk in PLWH.