AIDS in Rural America Bares Fear, Ignorance : Health: Small towns are not prepared to handle the disease or moral and political issues involved. Some make progress but others are in denial.

Linda Rudisill was killed by three bullets and her body was dumped along a remote road. Mary Young was beaten to death, run over by a car and left in the gutter.

Each woman had AIDS and told people so. Each had a criminal record and a history of violent behavior. And each, authorities say, was killed by a man near a small West Virginia town.

Lawyers and advocates for AIDS patients say the similar slayings, two counties and six months apart, illustrate AIDS’ arrival in the American countryside--and the fear and ignorance it can unearth.

“It’s getting to the point in these areas where it’s no longer them . It’s us ,” said Tom Dobbs, a state AIDS educator in Charleston.

AIDS is trickling into rural America where, experts say, people at all levels are ill-prepared to tackle the issues extending beyond medicine and into politics and morality.

“AIDS is becoming part of the background noise of our society, so people who haven’t been dealing with it now find they must,” said Jeremy Landau, executive director of the National Rural AIDS Network in Santa Fe, N. M.

Some places are answering with strength and tolerance. Support groups have cropped up from Bozeman, Mont., to Athens, Ohio, to the Mississippi Delta.

Other areas, however, refuse to cope.

“In general, rural communities are about two years behind cities,” said Landau, whose organization teaches small-town officials, doctors and clergy about AIDS.

“People get affected by AIDS and have no way of dealing with it,” he said, “because the community is in denial.”

In the 1980s, the AIDS “map” issued annually by the federal Centers for Disease Control to track the virus’ spread showed vast blank spots. Now, Landau said, cases of AIDS per capita are increasing faster outside cities.

AIDS today is found in nearly every area of every state, places where experts say it often is perceived as the big-city scourge of drug users and gay men.

New ways of coping are emerging, using time-tested techniques like religion and small-town support networks.

The AIDS Interfaith Network, based in Washington, D.C., takes the established social circuitry of religion and uses it to help urban and rural patients, executive director Ken South said.

Services cannot always keep pace and privacy can be nonexistent in areas where county health departments are the only places for miles that offer AIDS tests.

“Picture this,” South said. “It’s on the town square, with a sign that says ‘HIV testing down the corridor on the left.’ You go down the corridor and Mrs. Jenkins in motor vehicles, who sings with your aunt in the choir, says to herself, ‘Hey, what’s Sally Jones getting an AIDS test for?’

“What’s the good of having a confidentiality program when you’ve got Mrs. Jenkins over there in motor vehicles? You know how small towns are.”

In many areas, few doctors are familiar with AIDS, and money for high-maintenance care is lacking.

“Many people get diagnosed in the city and go back to their families to die. And they’re counted in the city, so the city gets the money for their care, but the small community has to care for them,” South said.

Like many rural states, West Virginia has seen comparatively little of AIDS’ horrors. Cases have been reported since 1984 but have reached double digits in only 12 of 55 counties. Ten counties never have dealt with even one AIDS case. And only 213 AIDS deaths have been tallied in the entire state.

“AIDS is kind of a New York problem or a California problem to people here,” said G. Ernest Skaggs, a defense attorney in Hinton. “It’s not a reality.”

Skaggs represented Young, the AIDS-infected woman who was beaten to death, in her earlier trouble with the law, and William Cody Harvey, the man convicted of killing Rudisill.

Harvey claimed self-defense in the June 27, 1992, slaying, contending that Rudisill told him she had AIDS and then began scratching him.

“I said, ‘Why the hell did you do that?’ ” Harvey testified. “And she said, ‘I gave you AIDS and you can die from that.’ ”

Harvey said he reached under the seat of his car, put a gun to the woman’s head and said, “And you could die from this.”

Preparing for Harvey’s trial in December, Skaggs went to grocery stores and crossroads gas stations for his own informal survey on attitudes about AIDS.

“Nobody really cared,” he said. “The comments I was getting, especially from older people, (were) pretty much that these two women got what was coming to them, that you live by the sword and you perish by it.”

In Webster Springs, authorities have said they are investigating ties between Young’s infection and her killing, which took place around Dec. 10, 1991. But they have not expressly linked the two, state police Sgt. Don Hinkle said.

That appears to matter little when the rumor mill grinds, prosecutor E. V. Morton Jr. said.

“The newspapers come up here, and people say what they want,” he said.

Anthony D’Augelli, a professor of human development at Penn State University, said the disease’s urban identity may be an obstacle to teaching about it elsewhere.

“It’s part of the social fabric in urban America. It’s not part of the social fabric in central Pennsylvania or other more rural places,” said D’Augelli, an expert on AIDS issues.

“Geographically, it’s not an equal-opportunity infection,” he said. “I don’t think there’s any clever way we can make somebody in a small town have the same sensitivity as someone living in a city neighborhood where half the people are HIV-positive.”

The fear of AIDS is not entirely medical, D’Augelli said.

“The biggest issue in all of this, of course, is homophobia,” he said. “Part of the reaction is having to deal with sexuality. That probably is the larger engine.”

But as more people contract AIDS, the rumor and innuendo will be replaced with a desire to learn, many say.

A coalition of groups called Federal AIDS Agenda ’93 is preparing a report on what communities need to fight AIDS and to accept its presence. The coalition, which focused especially on the countryside, plans to present its findings to President Clinton soon.

Landau expects a lot of innovative ideas, and says the time for action is at hand. It’s a fateful Catch-22, he says: the more people who have AIDS, the more people who know how to react.

“People in the cities didn’t want to deal with it in 1984, but they did. They learned. And there were no models then,” Landau said. “In rural communities, they’re realizing they need to create new models as well.”

Skaggs said the violent deaths of Rudisill and Young may not be typical reactions, but they show that the time to cope is here.