J. Kevin Carmichael is a family practice doctor at El Rio Special Immunology Associates, where he focuses on HIV/AIDS treatment and care. The clinic reported 21 AIDS-related deaths last year and gains about 15 new patients a month. It serves more than 1,500 HIV/AIDS patients. Carmichael, who has been in practice for more than 20 years, carries a list of those who have died with him. There are 457 on the list from the time he has spent at El Rio and another 150 from his service at the University Medical Center.

The HIV/AIDS death rate has dropped from 14 out of every 100 patients in 1995 to two out of every 100 today. Carmichael recently talked with Citizen Staff Writer Eric Sagara about the issues surrounding HIV/AIDS today.

Q. Why do you carry a list of HIV/AIDS victims with you?

A. The real reason I carry it around is that's a lot of people that have died. It's just kind of a reminder to me about what I am doing and why. When I get tired, when I get depressed, when I get upset, when I get angry, I look at that list and it reminds me of what I'm here for. I'm here to try to take care of people so they don't end up on that list. I'm also here to try to live up to the obligations that all those people who have died engendered in me. To me that's an obligation to not be quiet. It's an obligation to continue to work. It's an obligation to continue to try to do things better for people.

Q. Why has the death rate gone down?

A. We got the first access to the medicines that really worked in the beginning of 1996. Ever since '97 it's been about two deaths for every 100 patients. The thing that bugs me is why we can't get better. But you see 85 percent of those deaths were in people not on treatment. If all those people were on treatment, I'm assuming the majority of them wouldn't have died.

Q. What's being done to reach out to those people?

A. Those people actually are people that knew that they had HIV. We have in my office five continuing-care coordinators whose job is to try and keep those people in care. We're doing a lot of things to try and reach out to those people. Frankly, I think everybody should get tested. It's estimated that one-third of the people in this country with HIV do not know that they have it.

Q. How does President Bush's proposal to reinstitute the Ryan White Care Act impact what you do here?

A. That's a huge question. I think the Ryan White Care Act is the major source of funding for people with HIV in this country, and I think it needs to be reauthorized. I'm a little upset that what we're hearing is that it's going to be reauthorized but essentially in flat funding. So if we don't get an increase and we're going to enroll 185 patients next year, that means it's a decrease.

Q. Are there any other federal policies that are a concern to you?

A. The other concern that we have is quite a few of our patients are actually on Medicare and Ryan White actually is subsidizing the medications for those patients. I'm really worried about the new Medicare guidelines because I think there's huge holes in it and I think it might make things worse for people with HIV.

Q. Are there any HIV/AIDS issues specific to the region?

A. I also look at the cause of death in our practice and the leading cause of death in our practice is valley fever. It's interesting: Around the country most people are not dying from opportunistic infections. They're dying mostly from liver disease and other problems. Here it still remains valley fever, which is an opportunistic infection.

Q. How come we don't hear so much about HIV/AIDS education now?

A. I think you just don't hear about it because in some ways it's become part of the landscape. A lot of people know a lot about HIV right now, so that's a good thing. It's out there and people are doing education. Certainly the political climate has changed where people don't want to talk about sex or other things openly. Even HIV doesn't get as much press anymore. In fact it's rarely in the paper because I think people are getting tired of hearing about it. It's not quite as newsworthy, which is a little scary because this means we're becoming complacent. We've just accepted that there's going to be 40,000 new people with HIV in this country every year.