Why didn’t the patient return?

I saw a new patient today.  He came to the emergency room short of breath.  He told the doctors and nurses in the ER that he didn’t have HIV, or that he was unaware that he had it. A review of his chart showed a visit to a doctor at our medical center three years ago where an HIV test was done and came back positive. A note in the chart documents that he was contacted about this and told of the result.  A follow-up appointment was made. He didn’t come back.  Three years later he is in our emergency room short of breath. This is a bad sign.  Where has he been? What has he been doing? Why, when he started feeling short of breath and began losing weight over two months ago, why didn’t he come in then??

I ask him these questions and he has vague, evasive answers. One answer he gives is that he didn’t have insurance. I have a hard time understanding this as so many patients come through the emergency room who have no insurance and it doesn’t prevent them from seeking care.  I think there must be more to this story.