Disparities among migrant farmworkers in access to primary care

Background:  Among migrant farmworkers who use alcohol and other drugs in the U.S., the prevalence rate of HIV infection, possibly as high as 13.5%, is estimated to be 10 times the national rate. Migrant workers are disproportionately affected by HIV due to lack of access to health care services. The purpose of this report is to examine the distribution and characteristics of those having a primary physician in a sample of migrant farmworkers. 

Methods: Baseline data were utilized from an ongoing HIV risk reduction study in Immokalee, Florida. The sample for this study consisted of 431substance using migrant farmworkers, 29% of whom were newcomers.  Eight percent were HIV-positive.  Twenty-six percent reported having a primary doctor in Florida. Variables found to be significant at the bivariate level were entered into a logistic regression model with having a primary doctor as the dependent variable.  

Results: One-quarter (26%) of participants had a primary doctor, as did the majority (58%) of  HIV-positive participants.  However, 34% of participants stated that during the preceding three months, they had considered visiting a doctor but had not.  In the logistic regression analysis, having a  primary doctor  was significantly (p < .05) and postively associated with being female (Wald statistic = 7.42), having medical insurance (Wald = 39.44), and having children (Wald = 3.96), and inversely associated with being a newcomer (Wald = 5.61). The model accounted for 29% of the variance in having a doctor. The model correctly classified 90% of participants who did not have a doctor, 53% of those who did, and 81% overall.

Conclusions: This study found disparities in having a doctor among migrant farmworkers.  Further study should identify the sources of care for those without a primary doctor and identify the barriers to and means to increase their access to primary care.