Emergency Physician Provides HIV and Hepatitis C Testing, Counseling to Underserved Communities

Yvette Calderon, MD, FACEP, understood health disparities from an early age. Born to Puerto Rican parents who raised her in New York, she saw firsthand how language barriers and a lack of access to health care disadvantaged her family and others in her unprivileged Manhattan neighborhood. That’s when her desire to help people was born, and that desire still motivates her.

Today Dr. Calderon is known for her research into HIV and Hepatitis C prevention, but she didn’t start off on an academic track. She was 10 years into being an attending physician when she realized that to make an impact on the problems she was seeing in her ED, she would need a better understanding of how to do research.

“I also knew that in order to solve some of these problems, it would need some assistance in terms of finances,” Dr. Calderon explained. “I would only get that if I had a skillset that the grants people would see and say, ‘Oh, okay, so she knows what she’s doing,’ and would take a chance on me.” She got a fellowship with the Hispanic Center of Excellence at Albert Einstein College of Medicine that kickstarted her long, successful research career.

In the early 90s, Dr. Calderon was working in the Bronx and was seeing a lot of end-stage HIV in the ED. She wanted to reach patients earlier in the course of their disease so she could make a bigger difference.

At the time, those who wanted to get tested for HIV had to go to receive an hour of counseling and then wait a week for their results. As the science was progressing into point-of-care testing, Dr. Calderon and her colleagues started testing different options for providing HIV counseling in the ED. Wanting to be unintrusive to the flow of the ED, they developed educational and counseling videos and translated them into the common languages of their ED patients. Videos explained why to get tested, how to talk to your partner about testing, contraceptive options and more, and they could be watched while waiting the 20 minutes to receive test results.

“It was actually better to do video counseling,” Dr. Calderon explained. “Patients understood it better, and it could be done in different languages, and they were getting consistent messaging.”

Her work was funded by the Department of Health for the first 7-8 years of the program, allowing them to expand their screenings to different access points in the community—the local pharmacy, dental clinics, etc. Not everyone was on board with her project because they thought it was outside the scope of the emergency care team. But Dr. Calderon’s problem-solving instincts were too strong to ignore, and she felt strongly that her community would really benefit from proactive screenings.

“My position was always, it depends on where you are. If you have a high prevalence of a disease that you are taking care of in your ED, it’s absolutely a missed opportunity If we don’t offer some of these things that can actually help our patients either avoid and prevent disease or, at the very least, catch them early on so you can treat them,” she said. “That’s what’s happened with HIV. The face of HIV has changed totally because it’s now looked at as a chronic disease, people want to find it earlier. They want to treat it so that they can have as normal life as they can.”

When she took a new job as the chair and professor of emergency medicine at Mount Sinai Beth Israel, she brought this model of intervention with her. Her new community has a higher prevalence of Hepatitis C than HIV, so they began screening for that in the ED as well. Today, their patients can be screened for HIV, Hepatitis C and substance use disorder.

Dr. Calderon’s outreach program uses a health educator model, bringing in those who are interested in public health or medical school and are passionate about finding patients who need help and linking them to care. Though the health educators often stay only two or three years, Dr. Calderon thinks that turnover rate is ideal because they can operate with full emotional commitment to the program and then move on to new roles in public health. It also allows her to get more underrepresented individuals involved in the program.

“It was a pipeline program to diversify medicine,” Dr. Calderon said. “And we need that in the most desperate way.” She’s passionate about helping the next generation because without the encouragement of her mentors, Dr. Calderon never would have gone into medicine. Over the 20 years she’s worked on this project, most of her mentees have kept in touch and stayed in the public health sector.

Her impact on her local community and the broader medical community has not gone unnoticed. In 2022, Dr. Calderon received one of the highest honors in health care when she was elected to the National Academy of Medicine. What fuels her to keep going?

“I don’t like injustice,” Dr. Calderon explained. “If there are health outcomes that are not the same, and one group is benefiting more than another, one has to find that and then correct it. That’s our obligation.

“And I really believe emergency medicine signifies the social justice part of medicine because we see everything,” she emphasized. “We see humanity as its rawness come through the doors, and there are days that are harder than others, but we’re committed to taking care of those patients. We also need to be committed to making sure that our outcomes are equitable and that we’re doing as much as we can to eliminate any inequities.”

Looking back on her career to this point, Dr. Calderon says moving into research became a way to impact a whole community, instead of helping individual patients.

So, what’s next for Dr. Calderon’s research? She wants to expand her mission even further. Her goal is to figure out how to identify high-risk young people in prevalent HIV areas–those who don’t go to the doctor very often–so they can be linked to health care. Dr. Calderon’s Beth Israel team also wants to expand their outreach beyond HIV and Hepatitis C into a literal pain point for health equity—pain management.

It can be overwhelming work, she agrees, but she prefers to take a methodical approach to health equity problems, similar to the “organized chaos” she’s used to from the emergency department. Dr. Calderon encourages others to get involved in health equity efforts because “Every little bit that someone does adds to the correction of some of the things that are not right in medicine,” she said.

Her inner drive to help others, first sparked when the was a child living in the Manhattan projects, still burns bright today. Dr. Calderon focuses on the next step forward, one inch of progress at a time. One day, she’ll look back at how far she’s come.

“Ultimately, I want to be able to say that medicine is a little bit better off because people like me and my colleagues have invested ourselves in doing this work.”