National Health Statistics Reports

Number 107  January 25, 2018

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Main Reasons for Never Testing for HIV Among Women 

and Men Aged 15–44 in the United States, 2011–2015

by Isaedmarie Febo-Vazquez, M.S., Casey E. Copen, Ph.D., National Center for Health Statistics; 

and Jill Daugherty, Ph.D., National Center for Injury Prevention and Control

Abstract

Objectives—This report presents the percentage of men and women aged 15–44 

in the United States who have never been tested for HIV outside of blood or blood 

product donation based on 2011–2015 data from the National Survey of Family 

Growth (NSFG). Additionally, this report describes the main reasons reported 

for having never been tested for HIV. Data are shown by selected demographic 

characteristics and HIV risk-related behaviors.

Methods—NSFG data used in this report were collected through in-person 

interviews conducted between September 2011 and September 2015 with nationally 

representative samples of 9,321 men and 11,300 women aged 15–44 in the household 

population of the United States. The overall response rate for the 2011–2015 NSFG 

was 71.0%: 72.3% for females and 69.6% for males.

Results—Overall, 38.8% of women and 53.8% of men aged 15–44 had never 

been tested for HIV outside of donating blood or blood products. Non-Hispanic black 

women and men had the lowest percentages of those who had never been tested for 

HIV (20.8% and 32.2%, respectively) compared with the other Hispanic-origin and 

race groups shown. Never testing for HIV also varied by marital or cohabiting status, 

education, and sexual orientation. A lower percentage of women and men aged 15–44 

who reported any HIV risk-related sexual or drug behaviors in the past year had never 

been tested for HIV (26.4% and 33.7%) compared with those who did not report these 

behaviors (39.1% and 55.8%). The most common reason reported by women and 

men for having never been tested for HIV was that they were “unlikely to have been 

exposed to HIV” (72.0% and 71.1%), followed by they had “never been offered an 

HIV test” (21.0% and 21.1%). 

Keywords: HIV testing • human immunodeficiency virus • National Survey of Family 

Growth

Introduction

In 2013, more than 1.2 million 

persons in the United States were livin

with HIV, and 13% of those infected 

(one in eight) did not know they had th

virus (1). Persons who have HIV but ar

undiagnosed are estimated to account 

for one-third of HIV transmissions 

(2). Guidelines for HIV testing from 

the Centers for Disease Control and 

Prevention (CDC) recommend that 

clinicians screen all adolescents and 

adults aged 13–64 for HIV infection as 

part of their routine medical care (3). 

Multiple public health organizations, 

including the U.S. Preventive Services 

Task Force, also recommend that 

all adolescents and adults should be 

screened for HIV infection (4). More 

frequent HIV testing is recommended 

for persons who engage in behaviors 

known to increase the risk of HIV 

infection, including injection drug use, 

exchange of sex for money or drugs, 

same-sex sexual contact between men, 

and multiple sexual partners (3,4). Ther

is considerable evidence of the public 

health benefits of early detection of HI

including timely access to appropriate 

clinical care, optimized health outcome

and a reduction in the sex- and drugrelated risk behaviors that are associate

g 

e 

e 

e 

V, 

s 

d 
with HIV transmission (5–7). Routine 

HIV testing is an important component 

of the National HIV/AIDS Strategy (8). 

Despite public health efforts to expand 

opportunities for HIV testing, in 2015, 

more than 50% of adults aged 18–64 in 

the United States had never been tested 

for HIV outside of the mandatory testing 

done for blood or blood product donation 

(9,10). 

The National Survey of Family 

Growth (NSFG) provides nationally 

representative data on the HIV testing 

experience of persons aged 15–44 

in the general household population 

of the United States (11,12). This 

report highlights the demographic and 

behavioral characteristics of women and 

men who have never been tested for HIV.

Additionally, this report describes data 

on a new question added in 2011 on the 

main reason for never being tested 

for HIV. 

Methods

Data source

This report is based on NSFG 

data from 2011–2013 and 2013–2015 

combined, resulting in a data file of 

4 years of interviews from September 

2011 to September 2015. These two data 

sets together contain a total of 20,621 

interviews: 11,300 with women and 9,321 

with men, all aged 15–44. The overall 

response rate for 2011–2015 was 71.0%: 

72.3% for females and 69.6% for males.

NSFG was first conducted by the 

National Center for Health Statistics 

in 1973. It was at first conducted 

periodically. Since 2006, NSFG has 

been conducted continuously, with file 

releases for the 2006–2010, 2011–2013, 

and 2013–2015 surveys. This survey 

is based on nationally representative, 

multistage area probability samples 

and administered through face-to-face 

interviews conducted by trained female 

interviewers in the selected persons’ 

homes. Further information on sample 

design, fieldwork planning, interview 

content, and variance estimation for the 

current surveys was published 

previously (13). 

HIV testing measures

Since 1985, HIV screening has been 

conducted routinely in the United States 

for all donated blood and blood products. 

Due to this practice, NSFG respondents 

were first asked if they had ever donated 

blood or blood products, and the answer 

to this question was used to tailor the 

wording of the rest of the HIV testing 

questions. Specifically, respondents 

were asked if they had ever been tested 

for HIV outside of donating blood or 

blood products. If they were ever tested 

for HIV outside of this context, they 

answered several follow-up questions 

about their most recent test. Since 2011, 

if they responded “no” to “ever been 

tested for HIV” (i.e., never tested), or 

were only tested within the context of 

blood donation, respondents were asked 

their main reason for never being tested. 

Because the follow-up question about 

reasons for not being tested was asked 

of respondents who were never tested in 

any context and those who were tested 

only as part of blood donation (i.e., nonvoluntary screening), these two groups 

were grouped together for this report as 

“never testing for HIV.” This approach 

to asking about HIV testing is consistent 

with national preventive health goals to 

increase the proportion of individuals 

who have a routine and voluntary HIV 

test to learn their HIV status within 

the health care setting (3,8). This 

“never tested” group corresponds to an 

unweighted sample size of 4,164 females 

and 4,939 males. The HIV-related testing 

variables and their response categories 

are described further in the Technical 

Notes.

Selected demographic

variables

The data presented in this report 

are shown stratified by several 

key background and demographic 

characteristics, all based on the time 

of interview. Age is shown in 10-year 

groups. Educational attainment is 

shown only for respondents aged 22–44 

because large percentages of those aged 

18–21 are still attending school. The 

measure of marital or cohabiting status 

used in this report includes only those 

relationships with opposite-sex spouses 

or partners, in keeping with the recoded 

variables that have been defined 

across all NSFG surveys to date. The 

definitions of Hispanic origin and race 

used take into account the reporting of 

more than one race, in accordance with 

the 1997 guidelines from the Office of 

Management and Budget (14). 

Sexual orientation and HIV

risk-related behaviors 

Data on sexual orientation and 

selected HIV risk-related behaviors in 

NSFG are collected within the selfadministered portion of the interview, or 

audio computer-assisted self-interview 

(ACASI), where the respondent reads 

or listens to the questions and enters 

his or her own responses without 

assistance from the interviewer or 

disclosing responses to her. In ACASI, 

all respondents aged 15–44, regardless 

of reported sexual behavior, are asked a 

question about their sexual orientation, 

categorized as (a) heterosexual or 

straight, (b) homosexual or gay (or 

lesbian), or (c) bisexual. Further, this 

report includes measures of HIV riskrelated sexual and drug behaviors in the 

past year, as defined in a previous 

report (15). 

Statistical analysis 

All estimates in this report are 

based on sampling weights that were 

designed to produce unbiased estimates 

representative of women and men aged 

15–44 in the United States in 2011–2015. 

Statistics for this report were produced 

using statistical package SAS software 

version 9.4. The SURVEYFREQ 

procedure was used to estimate the 

sampling errors of the statistics in order 

to take into account the use of weighted 

data and the complex sampling design 

of the survey. Each table in this report 

includes standard errors as measures 

of the precision of the point estimates 

and percentages. Given the differences 

between men and women in both the 

use of sexual and reproductive health 

care services, which may include HIV 

testing (16), and the prevalence of HIV 

risk-related behaviors (17), this report 

presents results on HIV testing for 

men and women separately. Subgroup 

Page 2 National Health Statistics Reports  Number 107  January 25, 2018
differences within sex, as well as patterns 

of subgroup differences between men 

and women, are discussed. Overall 

associations between independent 

variables and never testing for HIV were 

evaluated using survey-adjusted Wald 

chi-square tests. A probability (p) level of 

less than 0.05 was considered statistically 

significant. Standard two-tailed t tests 

were used to test statistical significance 

among subgroups. Terms such as 

“greater than” and “less than” indicate a 

statistically significant difference. Terms 

such as “similar” or “no difference” 

indicate that the statistics being compared 

were not significantly different.

Results

Never tested for HIV by 

demographic characteristics 

(Table 1)

● For adults aged 15–44, the

percentage who had never been

tested for HIV was significantly

lower for women (38.8%) than for

men (53.8%). This sex difference

was also seen for those aged 18–44

(33.9% of women and 49.5% of

men).

● Having never been tested for HIV

was more common among women

and men aged 15–24 (63.9% and

73.7%, respectively) compared with

women and men aged 25–34 (26.9%

and 45.7%), and those aged 35–44

(26.4% and 41.5%).

● For both women and men aged

15–44, the percentage of those who

had never been tested for HIV was

higher among never-married, noncohabiting persons compared with

those in other marital status groups.

For example, approximately one-half

(55.5%) of never-married women

had never been tested for HIV

compared with 31.6% of those who

were currently married and 26.3% of

those who were currently cohabiting.

● For all Hispanic-origin and race

groups shown, non-Hispanic white

women (42.6%) were more likely

to have never been tested for HIV

compared with Hispanic (36.0%) and

non-Hispanic black (20.8%) women.

In contrast, a lower percentage

of non-Hispanic black men had 

never been tested for HIV (32.2%) 

compared with percentages for 

Hispanic (56.4%) and non-Hispanic

white (57.1%) men.

Women aged 22–44 with higher

levels of education were more likel

to have never been tested for HIV

compared with those with lower

levels of education. For example,

36.5% of those with a bachelor’s

degree or higher had never been

tested for HIV compared with

23.6% of women with less than a

high school education or General

Educational Development high

school equivalency diploma (GED).

The opposite pattern by education

was seen for men aged 22–44: Thos

with less than a high school diplom

or GED were more likely to have

never been tested for HIV compare

with those with higher levels of

education.

A lower percentage of women aged

15–44 identifying as bisexual had

never been tested for HIV (33.7%)

compared with women identifying a

heterosexual or straight (38.9%) an

women identifying as homosexual,

gay, or lesbian (46.4%). This patter

differed for men aged 15–44: Those

identifying as homosexual or gay

(28.7%) were less likely to have

never been tested compared with

men identifying as heterosexual or

straight (54.3%) or men identifying

as bisexual (47.8%).

●

y

e

a

d

●

s

d

n

Never tested for HIV by 

HIV risk-related behaviors 

(Table 2)

● Women and men who reported any

HIV risk-related sexual or drug

behaviors were less likely to have

never been tested for HIV (26.4%

and 33.7%, respectively) compared

with those who did not report these

behaviors (39.1% and 55.8%).

Lower percentages of women and

men who reported any HIV riskrelated sexual behaviors were never

tested for HIV (27.8% and 33.9%,

respectively) compared with those

who did not report these behaviors

(39.0% and 55.5%).

●

● Men who had a male sexual partner

in the past year were less likely

to have never been tested for HIV

(28.9%) compared with those who

did not have a male sexual partner in

the past year (54.4%).

There were no significant differences

in the percentages of those never

being tested for HIV among women

who had five or more opposite-sex

sexual partners in the past year

compared with those who had

fewer than five opposite-sex sexual

partners in the past year. However,

men with five or more oppositesex sexual partners in the past year

were less likely to have never been

tested for HIV (38.0%) compared

with those who had fewer than five

opposite-sex sexual partners in the

past year (54.4%).

Women and men who reported

any other HIV risk-related sexual

behaviors (not including male-tomale sex and five or more oppositesex sexual partners) were less likely

to have never been tested for HIV

(23.8% and 29.1%, respectively)

compared with those who did not

report these behaviors (39.3% and

54.4%).

Twelve percent of women who

reported any HIV risk-related drug

behaviors had never been tested for

HIV compared with 38.9% of those

who did not report these behaviors.

Nearly one-third of men who

reported any HIV risk-related drug

behaviors had never been tested for

HIV (29.1%) compared with more

than one-half of those who did not

●

●

●

report these behaviors (54.3%).

Main reasons for never 

testing for HIV (Table 3)

Tables 3 and 4 present data on the 

ain reasons for having never been 

ested for HIV among women and men 

ged 15–44 who had never been tested 

or HIV.

The most common reason for

having never been tested for HIV

among women and men was that

they were “unlikely to have been

exposed to HIV” (72.0% and 71.1%,

respectively).

m

t

a

f

●

National Health Statistics Reports  Number 107  January 25, 2018 Page 3
Page 4 National Health Statistics Reports  Number 107  January 25, 2018

● The second most common reason

reported for having never been teste

for HIV among women and men

was that they were “never offered

an HIV test” (21.0% and 21.1%,

respectively).

● Lower percentages (0.1%–3.1%)

of women and men reported other

reasons as their main reason for

having never been tested for HIV.

d

Main reasons for never 

testing by characteristics 

(Table 4)

Table 4 focuses on the two most 

commonly reported main reasons for 

having never been tested for HIV—

“unlikely you have been exposed to HIV” 

and “never offered an HIV test”—by 

selected demographic characteristics. 

The other reasons for having never been 

tested for HIV (shown individually in 

Table 3) were combined into a category 

labeled “all other reasons.” Due to the 

heterogeneity and small sample sizes of 

this group, these results are not discussed 

separately but are shown for illustrative 

purposes. 

“Unlikely to have been exposed to 

HIV” 

● For women who had never been

tested for HIV, there were no

differences by age group in the

percentages who reported “unlikely

to have been exposed to HIV” as the

main reason for having never been

tested for HIV. In contrast, a higher

percentage of men aged 25–34 and

35–44 chose this as their main reason

for having never been tested for HIV

(both 74.0%) compared with men

aged 15–24 (68.1%).

● For women and men, the percentages

who reported unlikely exposure

as their main reason for having

never been tested for HIV were

highest among those who were

currently married (77.4% and 77.8%,

respectively) compared with other

marital status groups.

● Significantly higher percentages of

non-Hispanic white women and men

reported unlikely exposure as their

main reason for having never been 

tested for HIV (77.8% and 78.9%, 

respectively) compared with all other 

Hispanic-origin and race groups 

shown. 

● The percentage of women and men

aged 22–44 who reported unlikely

exposure as their main reason for

having never been tested was higher

among those with higher education

levels. For example, the percentages

who reported this as their main

reason were 81.8% for women and

84.6% for men with a bachelor’s

degree or higher and 44.9% for

women and 59.9% for men with less

than a high school diploma or GED.

● For both women and men, there were

no differences by sexual orientation

in the percentages who reported

unlikely exposure as their main

reason for having never been tested

for HIV.

 “Never offered an HIV test”

● There were no significant differences

by age for women who reported

that they were “never offered an

HIV test” as their main reason for

having never been tested for HIV.

In contrast, a higher percentage of

men aged 15–24 (25.2%) reported

this reason compared with men aged

25–34 (18.5%) and 35–44 (16.2%).

● One-third of cohabiting women

reported never being offered an

HIV test as their main reason for

having never been tested for HIV

(32.6%), which was higher than

currently married women and

never-married women (19.2% and

19.6%, respectively). Among men,

a lower percentage of those who

were currently married reported

this as their main reason for having

never been tested for HIV (15.3%)

compared with those currently

cohabiting (23.0%) and those who

were never married (24.1%).

● Higher percentages of Hispanic

women and men reported that they

were never offered an HIV test as

their main reason for having never

been tested for HIV compared with

all other Hispanic-origin and race

groups shown.

● For women and men aged 22–44, the

percentages who reported that they

were never offered an HIV test as

their main reason for having never

been tested for HIV were higher

among those with less than a high

school diploma or GED (46.3% and

29.8%, respectively) compared with

those with a bachelor’s degree or

higher (14.5% and 12.4%).

● For both women and men, there were

no significant differences by sexual

orientation in the percentages of

those who reported that they were

never offered an HIV test as their

main reason for having never been

tested for HIV.

Main reasons for never

testing for HIV by HIV 

risk-related behaviors

The Figure shows the main reasons 

for having never been tested for HIV 

among women and men aged 15–44 who 

were never tested for HIV and reported 

any HIV risk-related sexual or drug 

behaviors in the past year. 

● Among women, 58.8% reported the

main reason for having never been

tested for HIV was that they were

“unlikely to be exposed to HIV,”

26.0% reported that they were “never

offered an HIV test,” and 15.1%

reported “all other reasons.”

● Among men, 62.7% reported the

main reason for having never been

tested for HIV was that they were

“unlikely to be exposed to HIV,”

27.8% reported that they were “never

offered an HIV test,” and 9.5%

reported “all other reasons.”

● The main reasons reported for having

never been tested for HIV were

similar between women and men

who reported any HIV risk-related

sexual or drug behaviors in the

past year.

Discussion

This report presents the percentages 

of those aged 15–44 in the United 

States who have never been tested for 

HIV outside of routine screening as 

part of blood donation and includes 

new information on their main reasons 
for having never been tested for HIV. 

Overall, 38.7% of women and 53.8% of 

men aged 15–44 in 2011–2015 had never 

been tested for HIV. Young persons aged 

15–24 were more likely than those aged 

25–44 to have never been tested for HIV. 

The greater prevalence of having never 

been tested for HIV among adolescents 

and young adults may inform programs 

aimed at reducing HIV infections in 

these populations. Although condoms 

are commonly used among adolescents 

(18), data suggest that there have been 

declines in condom use among this group 

(19). Adolescents and young adults may 

face age-related barriers to obtaining HIV 

testing services, including determining 

when and where to seek testing, limited 

knowledge about HIV, and concerns 

about confidentiality (20–22). In addition 

to age, demographic variation in the 

percentages of persons having never 

been tested for HIV was seen by marital 

or cohabiting status, race and ethnicity, 

education, and sexual orientation. 

This report also shows behavioral 

variation in HIV testing. The percentage 

of women and men aged 15–44 who 

reported having never been tested for 

HIV was lower among those who had any 

HIV risk-related sexual or drug behaviors 

in the past year compared with those 

who did not report these behaviors. This 

finding is similar to the patterns seen for 

recent HIV testing (i.e., in the past year) 

shown in a previous NSFG report (12). 

HIV testing as a routine part of medical 

care may increase the number of persons 

with HIV risk-related behaviors who 

are aware of their HIV status. However, 

about one in four women (and one in 

three men) aged 15–44 who reported 

HIV risk-related behaviors had never 

been tested for HIV. Some studies have 

suggested that HIV testing and HIV 

status awareness may play a role in 

reducing risk behaviors that may lead to 

HIV transmission, particularly among 

individuals engaging in behaviors that 

may increase HIV risk (7). 

Starting in 2011, NSFG respondents 

who had never been tested for HIV were 

asked for their main reason for never 

being tested. The most common reason 

reported among women and men aged 

15–44 was that they were “unlikely to 

have been exposed to HIV” (72.0% and 

71.1%, respectively), and the second 

most common reason was that they were 

“never offered an HIV test” (21.0% and 

21.1%). Persons who said that the main 

reason for having never been tested for 

HIV was that they were unlikely to have 

been exposed to HIV were most often 

younger (men only), currently married, 

non-Hispanic white, and had a bachelor’s 

degree or higher (limited to those aged 

22–44). Among those who reported any 

HIV risk-related sexual or drug behaviors 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure. Main reasons for never testing for HIV among women and men aged 15–44 who reported any HIV risk-related sexual or 

drug behaviors in the past year: United States, 2011–2015

National Health Statistics Reports  Number 107  January 25, 2018 Page 5
in the past year, unlikely exposure to HIV 

was the most common reason for having 

never been tested for HIV. Awareness 

of one’s HIV status is a key factor in 

improving individual health outcomes 

and reducing behaviors that may lead to 

new HIV infections (8).

Findings from this report should be 

viewed in light of several limitations. 

The cross-sectional design of NSFG 

does not allow for the timing of HIV 

risk-related behaviors and HIV testing to 

be determined. Second, as a householdbased sample survey of persons aged 

15–44, the NSFG sampling frame 

excludes those who are currently 

homeless, currently incarcerated or 

otherwise institutionalized, and those 

living on military bases in the United 

States. These groups may have different 

patterns of HIV testing behavior than 

those in households. Third, for this 

analysis, those who were tested for HIV 

only as part of blood donation and those 

who had never tested for HIV in any 

context were combined as “never tested 

for HIV”; these two groups may have 

different demographic and behavioral 

characteristics that were not examined 

in this report. A previous report on HIV 

testing using older NSFG data describes 

these differences in more detail (12). 

Last, the bivariate associations presented 

in this report may be explained by other 

factors not controlled for in the tables or 

included in the report. 

NSFG data on HIV testing are an 

important component of HIV behavioral 

surveillance among the general U.S. 

household population. In combination 

with community-based surveys and 

surveys of high-risk populations, 

nationally representative, populationbased surveys like NSFG can provide 

information to help evaluate and guide 

national HIV prevention strategies. 

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AIDS. Adolescents and HIV infection:

The pediatrician’s role in promoting

routine testing. Pediatrics 128(5):1023–9.

2011.

22. Copen CE, Dittus PJ, Leichliter JS.

Confidentiality concerns and sexual

and reproductive health care among

adolescents and young adults aged 15–25.

NCHS Data Brief, no 266. Hyattsville,

MD: National Center for Health Statistics.

2016.

Page 6 National Health Statistics Reports  Number 107  January 25, 2018
Table 1. Percentage of women and men aged 15–44 who never tested for HIV, by selected demographic characteristics: United States, 

2011–2015

Women Men

Characteristic

Number 

(thousands)

Percent 

(standard error)

Number 

(thousands)

Percent 

(standard error)

All persons aged 15–441 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

All persons aged 18–441. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Age group

15–24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

25–34 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

35–44 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Marital or cohabiting status

Currently married . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Currently cohabiting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Formerly married, not cohabiting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Never married, not cohabiting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Hispanic or Latino origin and race 

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Non-Hispanic

White, single race . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Black, single race . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Education2

No high school diploma or GED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

High school diploma or GED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Some college, no bachelor's degree . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Bachelor's degree or higher. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Sexual orientation

Heterosexual or straight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Homosexual, gay or lesbian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Bisexual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

61,263

55,741

19,937

21,091

20,236

23,342

9,035

5,099

23,787

12,303

34,087

8,407

4,786

11,422

14,601

16,813

55,966

982

3,694

38.8

33.9

63.9

26.9

26.4

31.6

26.3

16.1

55.5

36.0

42.6

20.8

23.6

22.8

26.3

36.5

38.9

46.4

33.7

(0.94)

(0.99)

(1.45)

(1.26)

(1.26)

(1.35)

(1.65)

(1.66)

(1.44)

(1.59)

(1.18)

(1.41)

(2.23)

(1.51)

(1.58)

(1.43)

(0.99)

(5.01)

(2.27)

60,875

54,765

20,596

20,762

19,517

22,041

8,078

3,107

27,648

12,908

34,304

7,286

13,673

16,751

16,944

13,506

57,894

1,053

1,172

53.8

49.5

73.7

45.7

41.5

46.6

45.0

36.8

64.0

56.4

57.1

32.2

70.2

50.0

50.8

45.7

54.3

28.7

47.8

(0.98)

(1.03)

(1.15)

(1.33)

(1.63)

(1.52)

(2.13)

(2.69)

(1.14)

(1.71)

(1.29)

(2.03)

(1.42)

(1.48)

(1.81)

(1.72)

(1.01)

(4.44)

(4.18)

1

Total includes persons of other or multiple-race groups and persons who reported “don’t know” or “refused” on sexual orientation; these groups are not shown separately.

2

Limited to persons aged 22–44 at time of interview. GED is General Educational Development high school equivalency diploma.

NOTES: All characteristics were measured at time of interview. Never tested for HIV includes respondents who had never tested for HIV in any context and those who only tested as part of blood 

donation. Chi-square test statistics for each variable by never testing for HIV were statistically significant (p < 0.05). 

SOURCE: NCHS, National Survey of Family Growth, 2011–2015.

National Health Statistics Reports  Number 107  January 25, 2018 Page 7
Table 2. Percentage of women and men aged 15–44 who never tested for HIV, by specified HIV risk-related behaviors in the past year: 

United States, 2011–2015

Women Men

Behavior

Number 

(thousands)

Percent

(standard error)

Number 

(thousands)

Percent

(standard error)

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

HIV risk-related behavior in the past year

Any HIV risk-related sexual or drug behavior1

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Any HIV risk-related sexual behavior2

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Male-to-male sex

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Five or more opposite-sex sexual partners 

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Any other HIV risk-related sexual behavior3

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Any HIV risk-related drug behavior4

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

61,263

2,841

57,527

2,526

57,857

...

...

1,047

59,525

1,684

59,238

442

60,585

38.8

26.4

39.1

27.8

39.0

33.4

38.5

23.8

39.3

12.0

38.9

(0.94)

(2.27)

(0.97)

(2.58)

(0.97)

 ...

 ...

(4.09)

(0.96)

(3.33)

(0.96)

(3.21)

(0.95)

60,875

5,487

54,074

4,846

54,769

1,593

58,604

2,432

57,456

1,237

59,300

1,122

59,340

53.8

33.7

55.8

33.9

55.5

28.9

54.4

38.0

54.4

29.1

54.4

29.1

54.3

(0.98)

(2.23)

(1.03)

(2.31)

(1.04)

(3.26)

(0.99)

(3.38)

(1.01)

(4.21)

(0.99)

(4.41)

(0.98)

... Category not applicable.

1

Includes male-to-male sex, five or more opposite-sex sexual partners, having had sex in exchange for money or drugs, having had sex with an HIV-positive sex partner, having had sex with a partner 

who injects illicit drugs, women with male partners who had sex with other males, illicit drug injection, crack cocaine use, and crystal methamphetamine use.

2

Includes male-to-male sex, five or more opposite-sex sexual partners, having had sex in exchange for money or drugs, having had sex with an HIV-positive sex partner, having had sex with a partner 

who injects illicit drugs, and women with male partners who had sex with other males.

3

Includes having had sex in exchange for money or drugs, having had sex with an HIV-positive sex partner, having had sex with a partner who injects illicit drugs, and women with male partners who 

had sex with other males.

4

Includes illicit drug injection, crack cocaine use, and crystal methamphetamine use. 

NOTES: Never tested for HIV includes respondents who had never tested for HIV in any context and those who only tested as part of blood donation. Chi-square test statistics for each HIV risk-related 

variable by never testing for HIV were statistically significant (p < 0.05), except for five or more opposite-sex sexual partners (women only).

SOURCE: NCHS, National Survey of Family Growth, 2011–2015.

Page 8 National Health Statistics Reports  Number 107  January 25, 2018
National Health Statistics Reports  Number 107  January 25, 2018 Page 9

Table 3. Percent distribution of the main reasons for never testing for HIV, among women and men aged 15–44 who never tested for HIV: 

United States, 2011–2015

Reasons for never testing for HIV

Women Men

Number 

(thousands)

Percent

(standard error)

Number 

(thousands)

Percent

(standard error)

Total who never tested for HIV � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 23,375 100�0 – 32,150 100�0 –

You have never been offered an HIV test� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 4,915 21�0 (1�12) 6,778 21�1 (0�97)

You are worried about what other people would think if you got tested for HIV � � � � � � � � � 96 0�4 (0�16) 115 0�4 (0�14)

It's unlikely you have been exposed to HIV � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 16,822 72�0 (1�33) 22,873 71�1 (1�22)

You were afraid to find out if you were HIV positive (that you had HIV) � � � � � � � � � � � � � � � 174 0�7 (0�15) 227 0�7 (0�15)

You don’t like needles � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 524 2�2 (0�34) 940 2�9 (0�41)

Never had sexual intercourse � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 246 1�1 (0�27) 113 0�4 (0�12)

No health insurance coverage or couldn't afford an HIV test � � � � � � � � � � � � � � � � � � � � � � � 21 0�1 (0�05) 45 0�1 (0�06)

Respondent reported spouse or partner tested negative � � � � � � � � � � � � � � � � � � � � � � � � � � – – 76 0�2 (0�07)

Some other reason� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 577 2�5 (0�33) 982 3�1 (0�36)

– Quantity zero�

NOTES: Percentages may not add to 100 due to rounding� Never tested for HIV includes respondents who had never tested for HIV in any context and those who only tested as part of blood donation�

SOURCE: NCHS, National Survey of Family Growth, 2011–2015�
Table 4. Percent distribution by main reason for never testing for HIV among women and men aged 15–44 who never tested for HIV, according to selected 

United States, 2011–2015

Women M

Characteristic

Number 

(thousands) Total

Unlikely you 

have been 

exposed to HIV

Never offered 

an HIV test

All other 

reasons1

Number 

(thousands) Total

Unlikely 

have b

exposed 

Percent (standard error) 

All persons aged 15–442. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Age group

15–24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

25–34 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35–44 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Marital or cohabiting status

Currently married . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Currently cohabiting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Formerly married, not cohabiting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Never married, not cohabiting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Hispanic or Latino origin and race 

Hispanic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Non-Hispanic

White, single race . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Black, single race . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Education3

No high school diploma or GED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

High school diploma or GED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Some college, no bachelor's degree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Bachelor's degree or higher. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Sexual orientation

Heterosexual or straight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Homosexual, gay or lesbian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Bisexual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

23,37512,585

5,5825,2077,2102,339

798

13,018

4,381

14,240

1,7311,1202,5173,7856,033

21,375

456

1,229

100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0

72.0 (1.33) 21.0 (1.12) 7.0 (0.60)

71.0 (1.73) 20.9 (1.36) 8.1 (0.91)74.1 (2.19) 20.7 (1.98) 5.3 (0.92)72.1 (2.50) 21.7 (2.30) 6.2 (1.12)77.4 (1.85) 19.2 (1.78) 3.3 (0.60)56.1 (4.10) 32.6 (3.73) 11.3 (2.45)65.6 (4.97) 26.6 (5.01) 7.8 (2.05)72.1 (1.67) 19.6 (1.35) 8.2 (0.87)

58.7 (2.51) 31.5 (2.05) 9.7 (1.25)77.8 (1.39) 16.9 (1.26) 5.2 (0.72)65.9 (3.08) 19.4 (2.57) 14.7 (2.20)

44.9 (5.52) 46.3 (5.35) 8.8 (2.39)64.6 (3.70) 28.4 (3.41) 7.0 (1.16)

74.4 (2.44) 17.7 (2.01) 7.9 (1.33)81.8 (1.96) 14.5 (1.77) 3.6 (0.88)72.5 (1.37) 20.7 (1.14) 6.8 (0.64)

67.8 (6.24) 18.8 (5.57) 13.4 (5.07)67.2 (4.25) 23.8 (3.84) 9.1 (1.79)

32,15015,015

9,2457,890

10,116

3,4821,135

17,415

7,126

19,194

2,3352,9225,4046,2495,967

30,920

302558

100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0100.0

71.1 (68.1 (73.8 (73.7 (277.8 (

66.2 (265.0 (368.7 (59.1 (278.9 (56.2 (359.9 (365.8 (274.1 (284.6 (71.2 (79.8 (662.3 (6

1Includes: “You are worried about what other people would think if you got tested for HIV,” “You were afraid to find out if you were HIV positive,” “You don’t like needles,” “Respondent reported spouse or partner tested nega

“Never had sexual intercourse,” “No health insurance coverage, or respondent couldn’t afford an HIV test,” and “Some other reason.”

2Total includes persons of other or multiple-race groups and persons who reported “don’t know” or “refused” on sexual orientation; these groups are not shown separately.3Limited to persons aged 22–44 at time of interview. GED is General Educational Development high school equivalency diploma.

NOTES: Percentages may not add to 100 due to rounding. Never tested for HIV includes respondents who had never tested for HIV in any context and those who only tested as part of blood donation. Chi-square test statistics for each variable by never testing for HIV were statistically significant (p < 0.05), except for age (women only) and sexual orientation.

SOURCE: NCHS, National Survey of Family Growth, 2011–2015.
National Health Statistics Reports

 Number 107 January 25, 2018 Page 11

Technical Notes

Definition of terms

HIV risk-related behaviors in the past 

year—This is a summary measure that 

includes HIV risk-related sexual or drug 

behaviors among women and men in the 

past year, including those who had five or 

more opposite-sex sexual partners; had 

sex in exchange for money or drugs; had 

a sex partner who injects illicit drugs; had 

an HIV-positive sex partner; for males, 

those who had any male sexual partners; 

and for females, those who had sex with 

male partners who had sex with other 

males. HIV risk-related drug behaviors 

include illicit drug injection and crack 

cocaine or crystal methamphetamine use 

in the past year. Further details on these 

measures can be found in a previous 

report (15).

HIV testing—The recode EVHIVTST

classifies respondents as ever having had 

an HIV test and in what context (i.e., as 

part of blood donation or outside of blood 

donation). The four categories for this 

recode variable were:

0 = No HIV test reported

1 = Yes, only as part of blood 

donation

2 = Yes, only outside of blood 

donation

3 = Yes, in both contexts

For this report, categories 0 and 1 

were combined as “never tested for HIV” 

and reflect the universe of respondents 

who were asked for their main reason for 

never being tested.

Main reason for never testing for 

HIV—If the respondent had never tested 

for HIV in any context or was only tested 

for HIV as part of blood donation, he 

or she was asked NOHIVTST (HE-2b 

female/IF-2b male NOHIVTST), which 

reads:

“Which one of these reasons shown 

on Card 88 would you say is the MAIN 

reason why you have not been tested for 

HIV?” ● You have never been offered an HIV 

test*

● You are worried about what other 

people would think if you got tested 

for HIV*

● It’s unlikely you have been exposed 

to HIV*

● You were afraid to find out if you 

were HIV positive (that you had 

HIV)*

● You don’t like needles* ● Some other reason* ● Respondent reported spouse or 

partner tested negative

● Never had sexual intercourse ● No health insurance coverage or 

respondent couldn’t afford an HIV 

test

The six response categories marked 

with an asterisk (*) were offered 

explicitly to the survey respondent, and 

the other categories were coded based on 

verbatim responses to the “other-specify” 

follow-up question. Table 4 shows data 

for the two most common reasons: “never 

offered an HIV test” and “unlikely you 

have been exposed to HIV.” All other 

reasons were combined into the category 

“all other reasons.” 
National Health Statistics Reports  Number 107  January 25, 2018

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Acknowledgments

The 2011–2015 National Survey of Family Growth (NSFG) was conducted by the National Center for Health Statistics (NCHS) with the support 

and assistance of a number of other organizations and individuals. Interviewing and other tasks were carried out by the University of Michigan’s 

Survey Research Center, Institute for Social Research, under a contract with NCHS. The 2011–2015 NSFG was jointly planned and funded by the 

following programs and agencies of the U.S. Department of Health and Human Services: 

• National Institute for Child Health and Human Development/Population Dynamics Branch

• Office of Population Affairs

• National Center for Health Statistics (CDC)

• Division of HIV/AIDS Prevention (CDC)

• Division of Sexually Transmitted Disease Prevention (CDC) 

• Division of Reproductive Health (CDC)

• Division of Cancer Prevention & Control (CDC)

• Division of Birth Defects & Developmental Disabilities (CDC)

• Office of Planning, Research and Evaluation

• Children’s Bureau of the Administration for Children and Families

NCHS gratefully acknowledges the contributions of these programs and agencies, and all others who assisted in designing and carrying out the 

2011–2015 NSFG. 

This report was prepared in the Division of Vital Statistics (DVS) under the general direction of Delton Atkinson, Director of NCHS’ DVS; Paul 

Sutton, Acting Chief, Reproductive Statistics Branch (RSB); and Anjani Chandra, Team Lead, RSB NSFG Team. The authors are also grateful 

for the valuable comments provided by Hanyu Ni, DVS Associate Director for Science and Amy M. Branum, NCHS Deputy Associate Director for 

Science.

Suggested citation 

Febo-Vazquez I, Copen CE, Daugherty J. 

Main reasons for never testing for HIV among 

women and men aged 15–44 in the United 

States, 2011–2015. National Health Statistics 

Reports; no 107. Hyattsville, MD: National 

Center for Health Statistics. 2018. 

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health Statistics

Charles J. Rothwell, M.S., M.B.A., Director 

Jennifer H. Madans, Ph.D., Associate Director 

for Science

Division of Vital Statistics

Delton Atkinson, M.P.H., M.P.H., P.M.P., Director 

Hanyu Ni, Ph.D., M.P.H., Associate Director 

for Science

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Internet: https://www.cdc.gov/nchs • Online request form: https://www.cdc.gov/info 

DHHS Publication No. 2018–1250 • CS287554

For more NCHS NHSRs, visit:

https://www.cdc.gov/nchs/products/nhsr.htm.