I've known my single-parent neighbor, "Jane," who is HIV-positive, and her two daughters for 11 years. Her younger daughter was infected at birth and is now 13, so Jane has been infected at least that long and does not use medication. The family is socially isolated and has no income except Medicaid and SSI. I met them when I was an undergrad doing volunteer respite childcare and have been available to Jane as a resource as well as a regular member of the kids' lives. Jane has always had some unusual beliefs and has been reclusive, but she was a loving parent. Over the past 8 months or so, the kids and I have seen personality changes, inappropriate anger, and very poor judgment. Jane runs out of money completely 2 weeks into each month (she used to budget carefully, and I suspect she is having trouble with calculation), and there is no food in the home. Jane doesn't seem to care that she cannot feed the kids, who are at my place every night the second half of the month, not having eaten all day. Jane has also exhibited abusive behavior with the older daughter (just turned 15), calling her a cunt, and getting into a physical fight with her in which Jane kicked her in the crotch and spat on her. Jane is irritable and bizarre when I visit her. She doesn't provide for the kids' school-related or other needs and interacts with them like an angry sibling: screaming, calling the 13 y.o. a "nerd," and telling the 15 y.o. she "hates" her and doesn't want to live with her anymore. The 15 y.o. is especially vulnerable because she is a survivor of early childhood sexual abuse (on top of everything else) and has psychiatric problems and special needs; she has no friends and has just had her first year back in school after 3 years' absence; she needs a lot of support, supervision and encouragement that she isn't getting. The kids say Jane spends her time either sleeping all day or "dancing" in her room to music. On the freeway, there was an incident of weaving and speeding when Jane was angry, and she almost hit a pedestrian. Jane told me she will not see a doctor or let them take her blood ever again, because she is not their "guinea pig," and she said she won't take meds because they will make her look old. She did not provide sanitary napkins or tampons when the 13 y.o. recently got her first period, and she herself just sleeps with a towel between her legs. I suspect HIV dementia - I don't think anything else could account for all of this. Jane doesn't know anyone in the area except for me, and she has no family she is close to or who is even willing to acknowledge her HIV diagnosis. I feel that I am in a terrible dilemma, because I am realistically the only option for the kids in terms of guardianship (kinship care) if Jane becomes temporarily or permanently disabled or passes away, and for this reason I have not been able to involve Child Protective Services even anonymously, as Jane would know I had been the reporter (I am the only one with such explicit knowledge of their home situation), and she would surely be furious and dissolve the relationship. I then would not be able to help the kids at all. The kids are naturally loyal to their mom and do not want to tell school/medical staff what is going on. As their only support person, I feel I should not be the one to blow the whistle (and CPS is not a reliable whistle to blow anyway), yet things are at the point where other systems need to become involved with the family. They are in chaos, and I worry constantly about the kids. Can you advise me?

You need to contact Child Protective Services. These children are being neglected and abused and they need help beyond what you can provide. I agree that Jane is probably suffering from HIV associated dementia. She also needs help and is more likely to agree to treatment if faced with the threat of losing her kids. She will not thank you if you allow her to continue this behavior until one of the children is seriously hurt.