Immigrant workers bear a disproportionate burden of poverty and ill health and additionally face significant occupational hazards. AgFF laborers largely are uninsured, ineligible for benefits, and unable to afford health services. The new Affordable Care Act will likely not benefit such individuals. Community and Migrant Health Centers (C/MHCs) are the frontline of health care access for immigrant AgFF workers. C/MHCs offer discounted health services that are tailored to meet the special needs of their underserved clientele. C/MHCs struggle, however, with a shortage of primary care providers and staff prepared to treat occupational illness and injury among AgFF workers. A number of programs across the US aim to increase the number of primary care physicians and care givers trained in occupational health at C/MHCs. While such programs are beneficial, substantial action is needed at the national level to strengthen and expand the C/MHC system and to establish widely Medical Home models and Accountable Care Organizations. System-wide policy changes alone have the potential to reduce and eliminate the rampant health disparities experienced by the immigrant workers who sustain the vital Agricultural, Forestry, and Fishery sector in the US.

Farm workers are vulnerable to irregular employment and job uncertainty. These conditions increase the likelihood they will find themselves in living and working sites where risk for HIV is present. Considering the exacerbated risk for HIV among unaccompanied male agricultural workers, a national non-profit farm worker health training and technical assistance organization planned and developed an HIV prevention-education toolkit to assist migrant and community health centers with HIV education to reach this population of vulnerable male farm workers. This article reviews iterative development of the toolkit in three phases, outlines the process whereby community input grounded the product in ways that were culturally responsive and linguistically appropriate for the target population of male farm workers, explores implications of the project as a national initiative to reduce HIV risks in a sizeable but dispersed community, and briefly describes how the overall project was assessed through community-based strategies.