Last week, the World Hepatitis Alliance released new research showing that just 55 percent of the 2.7 million Americans currently thought to be living with hepatitis C virus (HCV) are aware of their status. At this rate, the international advocacy coalition says it is unlikely that the United States will reach its own targets for HCV elimination by 2020, MD Magazine reports.

Global experts say “ignorance” and “stigma” among the American public are likely to blame. The WHA said increased screening for hepatitis C would alleviate the problem but that many health care professionals are still not comfortable asking patients about illicit drug use. Thus far, most risk-based screening has centered on baby boomers. Meanwhile, the U.S. opioid crisis continues to spread, bringing an increase in new HCV infections along with it.

The new data come from the Center for Disease Analysis Foundation in Colorado. In addition to showing a major lack of national awareness around hepatitis C, the study showed on a state-by-state level how public policy could make a difference in ending the epidemic. 

For instance, about two thirds of state Medicaid programs currently will not approve hep C treatment in the early stages of infection. Many states also limit coverage by demanding that patients abstain from drugs and alcohol use for at least six months before receiving treatment. Ultimately, that means that even patients who are aware of their status are often unable to do anything about their diagnosis.

That said, study authors said there is still power in HCV awareness. Once people know their status, they can help advocate for increased access to treatment. Organizations such as the WHA and its community partners can also help people find treatment through patient assistance programs, even if individuals are uninsured or their insurance won’t pay for treatment.

However, global advocates say that until more Americans get tested and know their status, it appears that the United States is a long way from HCV elimination.