Thank you very much, everybody.
All I can say is that this Texas hick got AIDS and is rushed to hospital after passing out.
The one who says these words to him is a gay guy who got AIDS too and is in his room.
And it seems that he really likes the Texas hick, but this one got this phobia of gays and so on.
He (the Texas hick) is really a hard and bad guy, but got his charm too.
You did an excellent job of explaining the context, chopin.
I agree that this is a kind of irony, but a friendly kind of teasing irony.
The Texan says disparaging things about gay men, but the gay man likes the Texan and the two are going to be friends. So the gay man compliments him "you are handsome" but reminds him of his shortcomings (as most people would see them): he is a hick and white trash. That is, (according to the stereotype) he is too narrow minded and uneducated to know much about what is going on in the world.
I think perpend and Cagey, sensitive to the context have made excellent points, and I want to revise my estimate in post #7, that the 'backhand' of the compliment is quite severe and harsh. In fact, and in context, it's 'over the top,' i.e. so extreme and blatant that one should best take it as playful, as when a friend says to you, "I saw you at the symphony and you seemed to greatly appreciate the program--considering you're an ignorant country bumpkin."