03/09/2026
By Chandni Shahdev

The Zuckerberg College of Health Sciences, Department of Public Health, invites you to attend a doctoral dissertation defense by Chandni Shahdev on “Impact of Bundled Intervention on HIV Stigma, Depression and Medication Adherence Among Black Women Living With HIV."

Candidate Name: Chandni Shahdev
Date: Tuesday, March 31
Time: 9-11 a.m.
Location: O'Leary 512 and Virtual
Meeting ID: 932 7187 6277
Passcode: 811720

Committee:

  • Advisor: Serena Rajabiun, Ph.D., MA, MPH, Department of Public Health, Zuckerberg College of Health Sciences, UML
  • Karyn Heavner, Ph.D., Department of Public Health, Zuckerberg College of Health Sciences, UML
  • Howard J. Cabral, Ph.D., Department of Biostatistics, Boston University School of Public Health
  • Yan Wang, Ph.D., Med., Department of Psychology, College of Fine Arts, Humanities and Social Sciences, UML

Abstract
BACKGROUND
Approximately 1.2 million individuals in the United States are living with HIV, with a disproportionate burden among Black women. In 2022, Black or African American women accounted for more than half of all new HIV infections. HIV-related stigma and depression remain key barriers to engagement in care and antiretroviral therapy (ART) adherence, yet limited longitudinal research has examined how stigma-focused interventions influence these outcomes. Guided by the Theory of Planned Behavior (TPB), this study aims to evaluates the impact of stigma reduction intervention as a part of a bundled intervention on stigma, depressive symptoms, and medication adherence among Black women living with HIV.
METHODS
This study addressed three aims. Aim 1 systematically synthesized HIV-stigma reduction interventions in the United States and summarized intervention characteristics and outcomes. Aim 2 conducted a secondary analysis of a multi-site bundled intervention implemented across 12 U.S sites (2021-2023), following 735 Black women living with HIV at baseline, 6months and 12 months. Linear Mixed-effects models accessed changes in stigma, depressive symptoms and medication adherence overtime and by intervention type (stigma-focused and non-stigma focused). Aim 3 evaluated whether changes in depressive symptoms mediated the association between change in stigma and change in medication adherence using counterfactual mediation analysis (SAS PROC CAUSALMED) and stratified analysis by intervention type.
RESULTS
The systematic review identified that stigma-reduction interventions in the U.S. remain limited and heterogeneous, with most programs focusing on individual-level internalized stigma and short-term psychological outcomes. In the multi-site initiative, participants had a mean age of 45 years; 66% were unemployed; 26% reported housing instability, and 43% reported a history of incarceration. Longitudinal analysis showed modest improvement in stigma, depressive symptoms and medication adherence over time, with no statistically significant difference by intervention types. Higher baseline values of stigma, depressive symptoms and adherence predicted greater reduction. Mediation analysis indicated a significant overall association between stigma and medication adherence (total effect β = −0.36, p < 0.001); and the indirect pathway through depressive symptoms was modest (β = −0.036, p = 0.076), suggesting depressive symptoms may represent one pathway linking stigma and adherence, alongside other psychosocial mechanisms.
CONCLUSIONS
Findings underscore the complex and multidimensional relationship between HIV-related stigma, mental health and HIV treatment outcomes. Depression may represent one pathway linking stigma reduction to adherence but additional mechanism (e.g., social support, self-efficacy) also contribute, hence future investigation is warranted. Integrating stigma screening and mental health support into HIV care, alongside multi-site stigma reduction strategies is needed to improve HIV treatment outcomes among Black women living with HIV.

All interested students and faculty members are invited to attend.