Advancing Human Rights and Access to Justice for Women and Girls

*Respecting, protecting and fulfilling womens rights, particularly the rights of the most marginalized women, is increasingly understood as fundamental to an effective HIV response. Laws reflecting unequal gender norms that discriminate against women may limit their ability to protect themselves from HIV infection. In many countries where women are most at risk for acquiring HIV, laws to protect women are weak (Mukasa and Gathumbi, 2008; Ezer et al., 2006; Ezer et al., 2007). Conversely, when people are able to realize the full range of their human rights, they are better able to protect and preserve their health through increased access to testing, treatment and care services (UN and OHCHR, 2011).

"The law can be a powerful tool for protecting women and girls and reducing their risk of HIV infection... Greater efforts to make laws work for women particularly in the areas of gender based violence and property and inheritance could dramatically strengthen the AIDS response." (Global Coalition on Women and AIDS, 2006)

Therefore, human rights must frame the legal responses to HIV. United Nations (UN) treaties and the Universal Declaration of Human Rights are the principle sources of international human rights laws and norms, which are complemented by protocols, declarations, international custom, and decisions and general comments issued by international and regional human rights mechanisms, among other sources. Most States have ratified at least four or more of the principal human rights treaties (OHCHR, ND), each of which outline rights that States have a duty to respect (e.g. by refraining from interfering directly or indirectly with the enjoyment of); protect (e.g. by preventing third parties from infringing on, and taking steps to investigate and punish such violations when they occur); and fulfill (e.g. by adopting whatever measures necessary legislative, budgetary, judicial, and/or administrative to achieve the full realization of rights).

However, challenges exist to translating international treaties into effective policies with enforcement (Gruskin et al., 2008c). Moreover, even where good laws are in place, women are often unaware of their existence, or have little access to the justice system. Therefore, adequate attention must be paid to implementation, which can include a number of promising legal strategies. This section reviews the legal environment for women and HIV and evidence of effective legal interventions. Unlike biomedical or other evaluated interventions, the evidence for a favorable legal environment relies more on advocacy or descriptive texts of programs than on studies, though there is increasing evidence of advocacy successes.

Five Priority Areas Require Legal Strategies to Address Womens Needs

This section provides an overview of key legal and human rights issues affecting women and girls that are critical to addressing HIV.

1. HIV-Related Discrimination Hinders HIV Prevention and Treatment Efforts

Studies have documented discrimination based on HIV status, including in the contexts of health care, employment, education and housing (Mukasa and Gathumbi, 2008). Invariably, HIV-related discrimination is compounded by other marginalized status. In Zimbabwe, for example, where HIV prevalence among sex workers has been reported to be over 60%, openly hostile attitudes and degrading behavior of health care staff has been found to dissuade sex workers living with HIV from engaging in HIV-related treatment and care (Mtetwa et al., 2013). Until very recently, HIV treatment was denied to all non-citizen prisoners in Botswana, leading to a significant deterioration in their health and potentially exposing other prisoners to the risk of contracting HIV (Southern Africa Litigation Centre, 2014).

While the law may be a slow and imperfect tool to respond to HIV-related discrimination, laws prohibiting such discrimination (e.g., broad anti-discrimination laws, constitutional protections against discrimination, HIV laws featuring specific protections against HIV-related discrimination) can create an enabling environment to protect the human rights of people living with HIV and are recommended by international human rights bodies (UNAIDS and OHCHR, 2006: Guideline 5). Notably, the number of countries reporting the existence of laws, regulations or policies protecting people living with HIV from discrimination increased from 56% to 73% among 85 countries between 2006 and 2010, although onethird of countries still do not have such legislation (UNAIDS, 2010e). [For more on stigma, discrimination and programming, see also Reducing Stigma and Discrimination]

2. Violence Against Women is a Human Rights Violation

Violence against women is a severe manifestation of gender inequality, all too often overlooked or diminished by police, the judiciary, community and religious leaders, and other authority figures [See Addressing Violence Against Women]. Transgender women and men in particular face significant risk of violence and harassment (Lombardi et al., 2001). [See also Transgender Women and Men] Increasingly, however, it is recognized that violence against women is a human rights violation that increases women's vulnerability to HIV, that HIV infection in turn increases women's vulnerability to violence, and that violence against women contributes to the conditions fostering the spread of HIV (WHO and UNAIDS, 2013).

Reforming existing laws that address sexual and domestic violence, or adopting new laws where laws are lacking, is one important aspect of governments' response and an obligation under international human rights law (CEDAW Committee, 1993). While nearly 125 countries have laws criminalizing at least some form of violence against women, there continue to be weaknesses in specific provisions, such as definitions of what constitutes violence and requirements for evidence.

3. Family and Property Laws Discriminate Against Women and Girls

Marriage, divorce and child custody laws are areas of particular importance for women in the context of HIV. Marriage is not a protective element for reducing risk of HIV transmission; in fact, in some places marriage is a womans primary risk factor. [See Prevention for Women] The absence of protective marriage laws (e.g., prohibiting forced marriage, child marriage, marital rape), as well as longstanding practices and customs (e.g., widow inheritance) can contribute to situations where women are unable to leave unwanted or abusive relationships or to negotiate safer sex. Correspondingly, women's inability or difficulty to obtain a divorce has serious implications for protection of women from HIV infection, as women whose spouses are living with HIV may stay married and continue to have unprotected sex. Women's lack of legal rights within marriage is often compounded by unfair child custody and maintenance arrangements and lack of property rights upon divorce. Where such discriminatory laws persist, women may perceive the negative economic and social consequences of leaving high-risk relationships to be more serious than the health risks of staying in those relationships.

"Without equal rights to acquire and secure property, a woman is effectively the captive of her husband and his family." (Global Commission on HIV and the Law, 2012: 66)

Closely related to the issue of discriminatory family laws is the issue of women's right to property and inheritance. In many countries, including those most affected by HIV (such as those in sub-Saharan Africa), women's property and inheritance rights are restricted (Izumi et al., 2009), with rights routinely denied either through law or through practice (Bennett et al., 2006; Ezer, 2006). Some countries do not acknowledge a woman's right to own an equal share of property with her husband during a marriage or when that marriage ends (CEDAW Committee, 1993). At the same time, many inheritance laws and practices continue to disadvantage women. Some women face discrimination when they receive a lesser share of a deceased's property by virtue of their gender, when they inherit property but are only considered the owner of that property for their lifetime as opposed to having full ownership, or when they are not given the same powers with respect to administering an estate that a man would be given in the same circumstances. And some women experience a phenomenon referred to as "property grabbing" where the widow's (and/or children's) house and belongings are illegally taken by relatives of her husband, a form of discrimination particularly common in households affected by HIV (Canadian HIV/AIDS Legal Network, 2009; Global Commission on HIV and the Law, 2012: 67). Not only are these gross violations of women's human rights, but such discriminatory laws and practices render women without access to productive resources, undermine their livelihoods and economic independence, limit their ability to control their sexuality and reproduction, destroy their ability to maintain adequate housing and leave many women almost entirely dependent on the men in their lives for basic economic survival. Women who lose their property also face difficulties in adherence to HIV treatment (Lu et al., 2013). In recognition of the links between women's rights to land and property and their right to health, organizations such as the World Health Organization (WHO), among others, have recommended that governments implement "legal and social measures that protect women's property rights" (WHO, 2009c). [See also Global Commission on HIV and the Law, 2012: Recommendation 4.4; UN Commission on Human Rights, 2005; CEDAW Committee, 1994: 1; Human Rights Committee, 2000: para. 26].

4. Criminalization of People Living With or Vulnerable to HIV Does Not Protect Women

Criminalization of HIV non-disclosure, exposure and/or transmission is widespread. According to the Global Network of People Living with HIV (GNP+), at least 600 people living with HIV in 24 countries have been convicted with HIV-specific or general criminal laws (GNP+, 2010). People living with HIV may be found criminally liable regardless of whether HIV status was disclosed, safer sex was practiced, HIV was actually transmitted or the risk of transmission was very low (UNAIDS, 2013a).

There are serious concerns that criminalization undermines HIV prevention efforts (Jurgens et al., 2009c). An overly broad use of the criminal law contributes to misconceptions around HIV and its transmission and undermines the relationship between patients, physicians and other service providers because people might avoid honestly communicating about their risky behaviours and disclosure practices for fear that this information may be used against them in an investigation (Mykhalovskiy, 2011). Criminalization also creates a disincentive for HIV testing, since ignorance of one's HIV status may be the safest way to avoid being accused of deliberately trying to transmit the virus (Forbes, 2010).

"Governments that criminalise the transmission of HIV may do so with the best of intentions, but the solution of criminal law does not fit the complex problems of vertical transmission of HIV. Scaling up PMTCT services and ensuring that they are affordable, accessible, welcoming and of good quality is the most effective strategy for reducing vertical transmission of HIV"(Csete et al., 2009: 160)

Closer analysis also reveals that criminalization does not reduce women's vulnerability to HIV or support women living with HIV, who may not be able to disclose their HIV status because of a risk of violence or because they are economically dependent on their partners (Csete et al., 2009). [See also Addressing Violence Against Women) Cases have also been brought against women, as in Burkina Faso (Sanon et al., 2009) and Zimbabwe (Mhofu, 2012). For pregnant women and mothers living with HIV, criminalization acts as a direct barrier to these women accessing care for themselves or their children. Laws may penalize vertical transmission, regardless of whether precautions are taken or available to women.

The criminalization of "key populations" (including but not limited to female sex workers, women who use drugs, trans women and women who have sex with women) also exacerbates stigma and discrimination against already marginalized communities and drives people away from HIV testing, prevention, care, treatment and support. [See also Prevention for Key Affected Populations and Reducing Stigma and Discrimination]

The criminalization of sex work, for example, exposes sex workers to stigma, discrimination and physical and sexual violence, limits their access to essential HIV, sexual health and harm reduction services, diminishes the control sex workers have over their working conditions (including negotiating power to insist on condom use) and increases their risk of HIV. [See also Female Sex Workers] In the context of drug use, punitive laws enforced against people who use drugs, including compulsory drug treatment, fuel the spread of HIV and keep users from accessing services for HIV and health care, including harm reduction services (Global Commission on HIV and the Law, 2012). Policing that targets women who inject drugs, in particular, exacerbates the risk of HIV infection, particularly for female sex workers who inject drugs who experience coerced sex and police abuse (Burris and Chiu, 2011). Where sex work is criminalized, transgender women, who are commonly profiled as engaging in sex work, have reported harassment and violence, including police extortion of sex or money in exchange for release from custody, and routine police confiscation of condoms or arrest based solely on condom possession, which is sometimes submitted as "evidence" of criminal activity.

"HIV has always been an epidemic of the vulnerable and legally disenfranchised." (Cameron, 2011: 103)In view of the public health impact of such laws, international health and human rights bodies have increasingly called on States to decriminalize sex work, same-sex conduct and drug use in order to meet core obligations of the right to health and to create an environment enabling full enjoyment of that right (Global Commission on HIV and the Law, 2012; UNAIDS and OHCHR, 2006; UN General Assembly, 2010).

5. Human Rights Abuses in Health Care Impede Access to HIV Prevention and Treatment

As the International Community of Women Living with HIV/AIDS (ICW) has noted, "Being both women and HIV positive renders positive women especially vulnerable to human rights violations. These include forced and coerced sterilization, refusal to provide services, hostile attitudes towards HIV positive women who seek to have children, stigmatization at hospitals by hospital staff, breaches of confidentiality, and testing for HIV without informed consent. Many of these violations occur during the provision of health services and are perpetrated by health service personnel" (ICW, 2009: 4). Marginalized communities such as sex workers, transgender people and people who use drugs are also subject to rampant human rights abuses in health care, ranging from inadequate or inappropriate health care services to denial of health care, to discriminatory treatment, harassment and violence from health care providers (Baral et al., 2011). [See also Women Who Use Drugs and Female Partners of Men Who Use Drugs] These abuses constitute violations of the right to the highest attainable standard of health, a right protected in the International Covenant of Economic, Social and Cultural Rights (ICESCR, 1966; Article 12) and the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW, 1979; Article 12).

"I feel like half a woman all the time. I can identify with other women but I know that Im different in a very sort of unusual way." (South African woman living with HIV describing the emotional impact of being involuntarily sterilized, cited in Essack and Strode, 2012: p. 28)Yet, some governments flout human rights in the name of public health. Forced HIV testing violates the right to security of the person, while the disclosure of ones confidential health information violates the right to privacy, rights guaranteed under the International Covenant on Civil and Political Rights, the ICESCR and other regional human rights instruments. UNAIDS and the Office of the High Commissioner for Human Rights (OHCHR) recommend that States "prohibit mandatory HIV-testing of targeted groups, including vulnerable groups" and "ensure that no testing occurs without informed consent, that confidentiality is protected, particularly in health and social welfare settings, and that information on HIV status is not disclosed to third parties without the consent of the individual" (UNAIDS and the OHCHR, 2006; Guideline 5, s. 22j) and s. 12). [See also HIV Testing and Counseling for Women]

Forced sterilization is another egregious human rights violation in health care settings. Since 2001, when forced sterilizations and coerced abortion among women living with HIV were first documented, reports have emerged from Chile, Venezuela, Mexico, Dominican Republic, Indonesia, Kenya, Namibia, South Africa, Tanzania, Thailand, Uganda and Zambia, with some women reporting being denied access to HIV and health services unless they agree to abortion or sterilization (Global Commission on HIV and the Law, 2012: 66). According to the CEDAW Committee, "Compulsory sterilization or abortion adversely affects womens physical and mental health, and infringes the right of women to decide on the number and spacing of their children" (CEDAW Committee, 1993: s. 22). UNAIDS and the OHCHR have similarly held that "forced abortions or sterilization of HIV-infected women violates the human right to found a family, as well as the right to liberty and integrity of the person" (UNAIDS and OHCHR, 2006: s. 118) and the UN Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment and the UN Human Rights Committee have recognized forced sterilization as a violation of the right to be free from torture, and cruel, inhuman, or degrading treatment or punishment (UN General Assembly, 2013; UN Human Rights Committee, 2000).

A Number of Legal Strategies Can Protect Womens Rights

Strengthening the enabling environment for women requires rights to be protected in both law and practice. While legal strategies are no panacea for human rights abuses, law has a critical role to play and in some cases, legal strategies can be the catalyst for powerful social change. The following are legal strategies that have been deployed by activists to promote women's rights on some of the key issues identified in the previous section.

1. Law Reform

Efforts to promote women's legal rights should ensure laws address the underlying gender imbalances that keep women from realizing their rights (Kim et al., 2008; ARASA, 2009). Many countries have made progress. Advocacy and activism by women's rights organizations in Latin and Central American countries have been instrumental in bringing about reforms on legislation related to violence against women in the past 15 years, including, for example, changing the status of sex crimes and spousal violence to public offences and broadening the definitions and sanctions for rape (WHO and UNAIDS, 2013: 65). In the area of family law, Ethiopia has reformed its laws to make child marriage under age 18 illegal (Ezer et al., 2006). In Lesotho, the Parliament enacted a bill providing married women who up to then were considered minors with status equal to their spouses, with rights to own land, the right to inheritance, and the right to have a bank account or to take out a loan without their husband's permission (Braun and Dreiling, 2010). And in Malawi, the 2011 Deceased Estates (Wills, Inheritance and Protection Act) protects widows from property grabbing (Symington, 2012).

In the area of criminal law, New Zealand passed a law in 2003 decriminalizing sex work in order to create a framework that "safeguards the human rights of sex workers," "promotes the welfare and occupational health and safety of sex workers" and "is conducive to public health" (Prostitution Reform Act 2003; s. 3). A number of countries have also revoked provisions criminalizing HIV non-disclosure, exposure and/or transmission to improve their HIV response. In April 2012, for example, the East African Legislative Assembly passed a bill applicable to the East African region protecting the rights of people living with HIV, prohibiting HIV-related discrimination, and requiring governments to ensure that women and girls have access to "women-specific and youth-friendly sexual and reproductive health services," "are protected from all forms of violence, rape and other forms of coerced sex, sexual and economic exploitation and traditional practices that may negatively affect their health" and "have equal legal rights in all areas including in matters such as marriage, divorce, inheritance, child custody, property and employment..." Importantly, the bill does not criminalize transmission under any circumstance, which could alter the domestic criminal law in the countries in the region where HIV exposure or transmission is criminalized (The East African Community HIV and AIDS Prevention and Management Act, 2012). In a review based on 18 months of research and testimony from 700 people most affected by HIV-related legal environments from 140 countries, the Global Commission on HIV and the Law found that the repeal of punitive laws created a more effective response to HIV prevention, treatment and care.

Recognition of transgender persons is another important recent development. Argentina, India, Nepal, Uruguay, Mexico and South Africa have created national legislation recognizing the rights of transgender persons to identify as such, enabling transgender people to use national health services and expect protection from violence "all ways of reducing HIV risk" (Global Commission on HIV and the Law, 2012: 53; WP no. 7455/2001/High Court of New Delhi cited in Maleche and Day, 2011). Significantly, Argentina has the first law globally that does not have requirements to change or assert gender identity, such as hormonal treatment, sex change operations, etc. The 2012 law states that gender identity is based on the person's volition (Argentina Gender Identity Law, 2012).

2. Strategic Litigation

Laws can also be reformed to protect the rights of women and girls via strategic litigation, which involves taking carefully-selected cases to court often those that create legal precedent and can bring about social, legal and political change by using an individual case of a human rights violation. As Pieterse concludes, rights-based litigation in South Africa, including in relation to HIV, may contribute to transformation by providing tangible relief to individual litigants and lending momentum to the overarching political struggles of social movements (Pieterse, 2008). As a tool for change, litigation has made great strides in promoting women's rights around the world by advancing marriage equality in Guatemala (ICHR, 2001a), protecting women from sexual harassment (Indian Supreme Court, 1997) and recognizing transgender identity in India (National Legal Services Authority v. Union of India Ors., 2012]), protecting women from domestic violence in Brazil (ICHR, 2001b) and holding men accountable for marital rape in Uganda and the Solomon Islands (Uganda v. Hamidu, et al., 2004; Regina v. Gua, 2012).

Most recently, there have been a number of successful cases in the context of property and inheritance rights. In 2007, for example, Law Advocacy for Women in Uganda challenged Uganda's Succession Act, which discriminated against women by granting a widow a significantly smaller proportion of the estate than a widower and removing a widows right to live in the marital home upon remarriage. The Constitutional Court found these provisions to be inconsistent with the sections of Uganda's constitution addressing human rights and invalidated them (Law Advocacy for Women in Uganda v. Attorney General, 2007). In 2008, the Kenyan High Court applied international human rights law to reject the argument that customary law revokes the right of daughters to inherit the estate of a father, thus upholding the right of the daughters in the case to inherit equally from the assets of their father's estate (In Re The Estate Of Lerionka Ole Ntutu, 2008). In Botswana, the Court of Appeal unanimously ruled in favor of four sisters in 2013 in Ramantele v. Mmusi and Others, by holding that the customary law of inheritance did not prohibit female or elder children from inheriting their deceased parents' family homestead. As a result, women in Botswana have the same rights, under customary law, to inheritance as men (Botswana Court of Appeal, 2013).

3. Engaging with Customary Legal Structures

In many countries, particularly in Asia and Africa, the situation for women is complicated by plural legal systems involving general laws that apply to matters in the public domain and customary/religious laws mostly concerning private and family life (Global Commission on HIV and the Law, 2012). Because of the prominence of customary or religious laws and practices in some environments, advocacy aimed at religious and customary leaders is essential, particularly on issues related to family and property. As the Global Commission on HIV and the Law has observed, "Perhaps the most promising route to change is adaptation of traditional legal systems to promote equality for women and their children, and recruitment of respected community members to mediate inheritance disputes between widows and their in-laws" (p. 68).

In Kenya, for example, the Kenya Legal and Ethical Issues Network on HIV and AIDS (KELIN) worked with customary legal structures to help reconstruct community-based mediation systems so that they respect Kenyan law and human rights in an effort to promote access to justice for widows and their children. By holding community dialogues with widows, elders and government officials and conducting training for elders and widows on the human rights provisions of Kenyan laws relating to property, customary structures such as councils of elders now mediate family disputes and help reinstate widows and children in their homes and family land (KELIN, 2012; update 2013).

4. Ensuring Access to Legal Services

Women's access to legal services is critical to successfully addressing the HIV response (Mukasa and Gathumbi, 2008; Acord et al., 2012). Yet all too often, laws that uphold womens rights are inadequately enforced because women lack access to legal services, a result of the high cost of legal services and court fees, long and inefficient court processes, inaccessible court locations and language barriers, among other barriers (Canadian HIV/AIDS Legal Network, 2009).

Accessible legal services can take a diversity of forms, such as legal aid, or the provision of legal services at no cost to people who would otherwise be unable to afford it. Legal aid can be delivered through specialized clinics serving people living with HIV (e.g., Uganda Network on Law, Ethics, and HIV/AIDS (UGANET), Uganda; KELIN, Christian Health Association of Kenya (CHAK) and Legal Aid Centre of Eldoret (LACE), Kenya)) or other marginalized communities, such as sex workers or people who use drugs (e.g., Womens Legal Centre, South Africa). Paralegal programs are another means to promote greater access to legal services, and paralegal programs directed at people living with HIV and run by "peers" have been carried out with documented success, particularly in sub-Saharan Africa (Open Society Foundations, 2013). In contrast to the traditional "lawyer-client" relationship, community-based paralegals equip community members to use the law to their benefit. Engaging with customary legal structures can also serve the broader aim of promoting access to justice by furnishing culturally accepted and often simpler and more affordable dispute resolution services.

5. Human Rights Education and Legal Empowerment Programs

Good laws and policies are but one step for meaningful change. Advocacy, awareness-raising and training for women to know their rights is critical if women are to realize and secure their rights (ICASO, 2010; IDLO and UNAIDS, 2010). In particular, legal empowerment projects can equip people with information about their rights and with the tools they can use to improve their social condition (Open Society Foundations, 2013). In Uganda, for example, a program to support women's property rights by training community members as paralegals helped increase awareness of (and reduced resistance to) womens property rights among community members and helped to empower women to enforce their property rights (Patel et al., 2014). Similarly, in South Africa, sex workers who had been trained on human rights and the law reported feeling more empowered and more confident to directly challenge the human rights violations they endured because of the legal information they had received (Open Society Foundations, 2013).

6. International and Regional Human Rights Advocacy

Regional and international human rights advocacy can complement domestic human rights advocacy or offer a venue to continue efforts to protect and promote women's rights. Governments are bound by the treaties that they have ratified and for each human rights treaty, there is an enforcement mechanism to ensure governments comply with their obligations. Enforcement generally takes place through individual complaints, inquiries into grave and systematic human rights violations or periodic government reports. The Human Rights Council is another UN entity responsible for strengthening the promotion and protection of human rights, including through the "Universal Periodic Review" (UPR) of Member States of their human rights obligations and commitments. Civil society can participate in the UPR process by submitting information about the human rights situation in their country and by making statements at the regular session of the Human Rights Council when the outcome of the State reviews is considered.

Other forms of international human rights advocacy involve engagement with "Special Procedures" or temporary thematic or state mechanisms to draw attention to specific issues. These could be Special Rapporteurs, Working Groups or Independent Experts who are mandated to receive complaints and act on the basis of communications disclosing human rights violations. Of particular relevance to the issue of women and HIV are Special Procedures on violence against women, discrimination against women in law and practice, the right to health, the right to adequate housing, and torture. In 2010, for example, the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health examined the relationship between the right to health and the criminalization of same-sex conduct and sexual orientation, sex work and HIV transmission (UN General Assembly, 2010).

An illustrative example of international human rights advocacy concerns the sterilization of F.S., a Chilean woman living with HIV, without her informed consent. F.S. filed a complaint against the operating surgeon which was ultimately dismissed, and subsequently filed a lawsuit before the Inter-American Commission on Human Rights and made submissions to the CEDAW Committee criticizing the treatment of women living with HIV in Chile. In 2012, the CEDAW Committee issued concluding observations urging the Chilean government to ensure that fully informed consent "is systematically sought by medical personnel before sterilizations are performed, that practitioners performing sterilizations without such consent are sanctioned and that redress and financial compensation are available for women victims of non-consensual sterilization" (CEDAW Committee, 2012: para. 35).

Resources for Action

Numerous resources exist to assist advocates, policymakers, the judiciary and service providers to enact and uphold laws that respect, protect and fulfill women's rights on the key issues discussed in this section. A small sampling of key resources includes:

2014 Update:

Chu, S., J. Gay, M. Croce-Galis, N. Duffau Valdes, K. Hardee. 2014. Strengthening the Enabling Environment - Advancing Human Rights and Access to Justice for Women and Girls.What Works for Women and Girls: Evidence for HIV/AIDS Interventions. New York: Open Society Foundations. With thanks to Tamar Ezer, E. Tyler Crone, Alison Symington, Mayra Gomez, Priti Patel, Allan Maleche and Johanna Fine.