Starting a Support Group for Families and Partners of People with HIV/AIDS in a Rural Setting

Abstract

Starting and maintaining a support group for families and partners of people living with HIV/AIDS (PLWAs) is more complex in a rural setting than in an urban setting, where diversity and anonymity are the norm (Eberle, 1992). This article describes the formation and content of such a group in the town of Keene in rural, politically conservative New Hampshire. The Community The town of Keene, with a population of 22,430 in 1990, was settled in the 1730s (Keene History Committee, 1968). It has a grandly wide Main Street and square, which were laid in and hark back to a pre-revolutionary time, with a stately church, town hall, and common. No railroads or highways connect Keene directly to urban centers. Only one local newspaper competes with the ultraconservative Union Leader, distributed statewide. Many businesses open by 8:00 A.M., because Yankees by nature are early risers, and everything is closed by 9:00 P.M. The few bars connected to restaurants dose by midnight. Catholic, Protestant, Greek Orthodox, Unitarian, and Mormon churches and a synagogue are part of the community, and fundamentalist congregations have proliferated in recent years. There are no high-rises in the area, and in the spring and summer many of the tree-lined streets look much as they did during World War II. Although Keene prides itself on having two small colleges, it is not considered a college town; students come and go in the spring and fall without preceptibly altering the rhythm of life. Traditional marriages and living arrangements prevail. Those who identify themselves as different in this rural setting usually travel outside the area for socialization to avoid stigmatization and ostracism. The lesbian community is somewhat visible, but the gay male community is still quite closeted, although there is an organization for gay men. Gay people are not out professionally in the area, and the existence of gay families is not known. Social Setting Church and still constitute the most important and trusted arenas for acceptance and socialization (Brandt, 1991). Socializing is primarily couple oriented; single people are not generally included in private gatherings. Family and community connections go back generations. Long relationships, old ties, and debts that are more than financial and marital result in enmeshment and create a setting in which members must struggle for individuation and privacy. At the same time, many families work hard at keeping family business private, resulting in an atmosphere of false homogeneity. Fear of ostracism is a powerful social control. Because identity and prestige vis-a-vis others in the community are so dependent on social approval, disclosure of HIV infection or an AIDS diagnosis is potentially terrifying and isolating (Brandt, 1988). These social pressures influenced the emergence and ongoing success of a support group for members and partners of PLWAs that responds to client and isolation by creating a safe, supportive network (Sontag, 1989). Support Group Start-up Until 1989 attempts to establish support groups for PLWAs and their loved ones were unsuccessful. In the fall of 1989, several factors converged to provide key ingredients for the start-up of an ongoing group. The catalyst was a woman who was native to the area and who had lost a member to AIDS. She was willing to be visible, impervious to ostracism, and determined to give the death meaning in the larger community. Her public appearance was reported by a sympathetic local newspaper editor, and several women contacted her through the United Way Helpline. Because of concern about public exposure and to ensure safety and privacy, the first meeting of a group of four took place in the founder's home, and the group continued to meet there for 14 months. In the first meetings individuals consistently expressed anxiety about being seen and about information leaks about the group's existence to outsiders. …