Hilda Ortiz-Morales, ACNP, MSN, PhD, has a history with HIV prevention and treatment—a history that nearly traces back to the origin of the HIV/AIDS epidemic in the United States. With degrees from Lehman College and the College of New Rochelle, Ortiz-Morales has spent 34 years as a nurse practitioner, many of those years at Montefiore Medical Center, one of the busiest hospitals in the Bronx, New York.
Like many registered nurses, Ortiz-Morales had wanted to work in the field since childhood. Her mother was chronically ill, requiring visiting nurses. “The care and caring they provided my mother left a lasting impression on me,” she says. “I knew then that I was going to become a RN when I grew up.”
With immigrants from the Dominican Republic, Jamaica, Ghana, Bangladesh, and many other nations, the Bronx is an extraordinary example of America’s increasing diversity. With a population of 53% Latinos, 30% African Americans, 11% whites, and 3% Asians, the Bronx differs from the average American county in several ways. Almost one-third of its residents were born outside the United States, half of its children are born to foreign-born mothers, and the borough stands as the first borough in New York City to have the majority be people of color.
While the Bronx benefits from its diverse population, historic problems of poverty and poor health continue to plague its residents. The Bronx is one of only five American counties to have more than 30% single-parent households. In New York City, neighborhoods as varied as mostly black Harlem, and mostly white Chelsea, are familiar with the devastation brought by the HIV/AIDS pandemic.
The Bronx is no exception. African Americans represent 12% of the U.S. population and are the second-biggest minority in the Bronx. Yet according to 2010 statistics from the Centers for Disease Control and Prevention (CDC), blacks accounted for about 41% of people living with HIV. Things are especially dire for young black men who have sex with other men (MSM). In 2010, 4,800 new HIV infections occurred in this group. Young black MSM represented 45% of black MSM who newly became infected and 55% among all young MSM newly infected.
Nurses, working at places as varied as hospitals, private clinics, and community centers, are using their scientific knowledge, as well as their helping, healing “soft” knowledge, to educate vulnerable populations about HIV and STDs. Cultural competency is key to reaching people who feel marginalized by mainstream medicine.
“My experiences include infectious diseases, HIV/AIDS, critical care, utilization management/quality assurance, medicine, and surgery,” Ortiz-Morales continues. She currently works at the Montefiore Infectious Diseases (ID) Clinic, where she serves as coordinator and primary clinician of the HIV/Hepatitis C virus (HCV) specialty service. While HCV doesn’t get the constant attention of HIV/AIDS, it’s a serious sexually transmitted infection that many people with HIV have concurrently. The HIV/HCV specialty program evaluates and treats all co-infected and mono-infected patients treated in the ID clinic.
Ortiz-Morales works to educate patients—and the community in general—about HIV and STD misconceptions, such as the “lack of understanding about the acquisition of STDs among adolescents and adults in the Bronx.” Young people bare the brunt of sexually transmitted infections, HIV, and unintended pregnancies. Case in point: Young people aged 15 to 24 years acquired half of all new STDs in 2013, according to the CDC’s Sexually Transmitted Diseases Surveillance statistics. The Bronx, in particular, has several zip codes with some of New York City’s highest rates of STDs and HIV.
Recognizing the importance of HIV/STD testing as prevention and treatment strategy, Montefiore’s Emergency Department launched an initiative to offer HIV testing to all patients coming in for treatment.
“This mandatory offer is the latest example of Montefiore’s commitment to drive AIDS awareness and deliver seamless care to patients with HIV/AIDS,” says Ortiz-Morales. Montefiore also offers the Adolescent AIDS Program (AAP). AAP provides comprehensive care to HIV-positive youth, as well as risk reduction and HIV counseling and testing services for such high-risk groups as young men who have sex with men, intravenous drug users, and young people involved in sex work.
The increasing attention to hepatitis C influences Montefiore’s newest initiative, Project INSPIRE NYC. According to Ortiz-Morales, Project INSPIRE NYC “is an integrated, innovative, and evidence-based comprehensive service model that … demonstrates a model of service delivery and payment that can reduce morbidity and death from chronic hepatitis C … [and] reduce costs associated with its complications.”
Of the estimated 146,500 New Yorkers with chronic hepatitis C, about half do not know that they are infected, according to the New York City Department of Health. Over the next three years, clinicians at Montefiore plan to use an integrated model of care for Medicare and Medicaid patients at risk for hepatitis C. Primary care clinicians work closely with care coordinators and specialists to increase access to effective hepatitis C care for patients. HCV care coordinators provide care coordination, navigation, health promotion, and medication adherence to each patient; they also work with a peer educator. The peer educator is a person formerly with hepatitis C, who shares his or her experiences and helps patients navigate through the process.
The Bronx represents both the best and worst developments in 21st-century America. The future of this borough’s young people, as well as people of all ages and backgrounds, is dependent on nurses comfortable with sexual intelligence, reaching people without judgment.
Behlor Santi is a freelance writer based in New York.