What factors related to the location and culture of this rural community may have affected this case? How might the situation have been different in an urban setting?

Question

As an employee of a private, nonprofit HIV/AIDS clinic in a rural North Carolina community, Linda Summerfield’s job was to provide direct services to people with HIV/AIDS as well as to connect them with resources. Aware of their needs, she also respected their need for confidentiality and anonymity in an area where issues surrounding HIV/AIDS were highly charged and prejudice was common. In 1999, Linda was also eager to help six men in her caseload who were struggling with uncertainty, loneliness, and isolation. Aware of their shared needs, she believed in the healing power of group work for such clients. Although initially reluctant, the six men agreed to “meet” via telephone and, despite their apprehension and some technical difficulties, after five weeks all agreed that the experience was helpful. But when meeting via telephone became unworkable, Linda faced decisions over whether and how or where to persuade the men to continue meeting.

Answer 1

In the Casper area, as in many rural areas, maintaining confidentiality could be very difficult. Familiarity and an informal network of information sharing make anonymity unlikely. In an urban area, confidentiality and anonymity probably would have been easier to maintain.
Rurality and distance from a metropolitan area may have prevented access to necessary technology to continue the telephone group as well as the isolation felt by these clients. In addition, the provincial nature of this rural community included ideals and values which often manifested as prejudice and reluctance in the community to support the mission and services of Daybreak. A gathering of gay men could have aroused suspicion, rebuff, and even violence.
While there was no assurance that this situation would play out differently in an urban area than in this rural part of North Carolina, the differences between urban and rural communities could be extensive, particularly in terms of anonymity and accessing resources. While prejudice exists in urban settings as well, a larger population might provide a larger pool of individuals offering social support. In urban locations there may be more diversity of values and opinions and it may have been easier for the men to locate pockets of supportive people. In addition, clients from an urban area may have been less isolated from others experiencing HIV/AIDS with more agency choices. Generally, urban areas may have more social service options and newer technologies, and travel distances to access services probably would have been shorter.