Many adults never get tested for HIV. Here are a few reasons why.

Stigma and embarrassment still keep many young people and adults from getting tested for HIV, experts say.

The National Center for Health Statistics reported earlier this month that just over one-third of women and more than half of men ages 15 to 44 in the United States had never been tested for the virus, outside of donating blood or blood products. The conclusions were based on data that the National Survey of Family Growth collected between 2011 and 2015, with national samples of 9,321 men and 11,300 women.

Even fewer women and men who reported high-risk behaviors like drug use had been tested – 26.4 percent for women and and 33.7 percent for men.

The report is the first time the National Survey (a division of the Centers for Disease Control and Prevention) has published data on why people never get tested for HIV, according to a blog post from Isaedmarie Febo-Vazquez, an epidemiologist and lead author of the report.

The most common reason respondents gave for never being tested was “unlikely to have been exposed to HIV,” followed by “never offered an HIV test,” according to the report.

“As a health care professional, I didn’t find this surprising,” said Andrea Mulholland, a family nurse practitioner with Orange County Health Department. Lack of exposure is a consistent reason she hears for not being tested. Like all county health departments in the state, Orange County offers free testing, and sees “the whole range” of people, those with high-risk behaviors and low-risk, Mulholland said.

The Centers for Disease Control and Prevention recommends that doctors screen patients ages 13 to 64 for HIV infection as part of regular care. It recommends more frequent testing for people who are engaged in high-risk behaviors for HIV, such as having multiple sexual partners and injecting illegal drugs. The CDC also estimates that people who have HIV but are not diagnosed account for one-third of HIV transmissions.

An estimated 36,700 people were living with HIV or AIDS in North Carolina at the end of 2016, according to the N.C. Department of Health and Human Services. Of this number, an estimated 2,500 are undiagnosed and unaware that they are infected.

About 34,000 people were diagnosed with HIV and living in North Carolina in 2016, the state reported. In 2016, 1,399 adults and adolescents were newly diagnosed with HIV/AIDS, according to state figures.

“Even though these are the recommendations ... a lot of people we see here in the health department don’t feel comfortable discussing their sexuality” with a primary care doctor, Mulholland said. People who get tested at the clinic feel more comfortable and safe because the health department does not bill third-party providers, she said.

In some parts of the state, going to a public health department still carries stigma, Mulholland said.

There may be “system level barriers” that keep patients from consulting their primary doctors, said Arlene Seña, medical director at the Durham County Health Department and an associate professor in the UNC School of Medicine. Despite the guideline for annual testing, many primary care doctors may be too busy checking for hypertension, diabetes and other health issues, and may simply not have the time to test for HIV, she said. And some patients feel a stigma talking about HIV and sexually transmitted diseases, Seña said.

Seña found the high numbers of people who had never been tested surprising.

“It’s a complicated issue,” she said. “I don’t think we have all the answers why this survey found these numbers,” Seña said. She sees a need to increase awareness of testing among those who are not in high-risk groups, and to find more information about the barriers that keep people from getting routine testing with their primary doctors.

This story was originally published January 31, 2018 at 2:43 PM with the headline "Many adults never get tested for HIV. Here are a few reasons why.."