It’s no easy feat mobilizing world-renowned organizations to collaborate together around a common, highly challenging cause. And for anyone familiar with the global health sector, change doesn’t happen overnight. But for Gary Cohen, Founder of Together for Girls, change is possible with “deep passion, common motives, effective facilitation, and constant persistence.”
That’s how he founded Together for Girls in 2009, bringing together leading organizations from across sectors to form a global partnership working to end violence against children, particularly sexual violence against girls. In celebration of Together for Girls' 10-year anniversary, we sat down with Gary to learn more about how Together for Girls came to be — where it all began, the challenges, the successes, and what’s next.
Learn how Gary’s background in the private sector and his extensive experience in global health, cross-sector engagement and social impact helped him build a first-of-its-kind multi-sectoral partnership leading the movement to end sexual violence against children.
TfG: Can you share a bit about your background and how you became such a passionate advocate and leader in the field?
Gary: By education, I’m an MBA and most of my professional experience has been as an executive in the business sector. But several decades ago, my internal compass pulled me in a new direction. I was drawn to collaborate across the public, private and non-profit sectors to help address global health issues.
As part of this work, I travelled extensively to developing countries, particularly in Africa, to bring much-needed engagement and support in combating infectious disease pandemics such as HIV & AIDS and TB. I also helped mobilize support to combat the Ebola epidemic in West Africa in 2014. I was invited to join the boards of several prominent organizations, such as UNICEF USA and the CDC Foundation.
So, while my formal training was in business, my passion is taking on major health challenges, particularly those affecting vulnerable populations, and partnering with like-minded leaders and organizations to address these challenges. I’ve done this in various areas such as protecting health workers and patients – particularly children – from disease spread, strengthening health systems in low resource countries, innovating to reduce maternal and newborn mortality, and combatting major threats such as antimicrobial drug resistance. For more than 35 years, I have been fortunate to work within a company, BD (Becton, Dickinson and Co.), which allows this type of work to flourish.
TfG: Why was the Together for Girls partnership founded? What was happening in the field 10 years ago that prompted you to take action?
Gary: In the mid-2000s, while I was traveling extensively in sub-Saharan Africa during the HIV & AIDS pandemic, I kept coming across a consistent and very concerning problem.
Among the HIV-infected youth and young adults that I met during my travels, approximately three-quarters were girls and young women, while only one-quarter were boys and young men. That observation struck me. It was apparent that girls and young women were not being infected by their male counterparts of the same age–they were being infected by men considerably older than them. I dug deeper into this issue and uncovered the many injustices girls experience with respect to sexual violence. I discovered this didn’t only impact their vulnerability to HIV; it also impacted their health and human rights in so many other ways.
Girls who experienced sexual violence were more likely to have an unwanted pregnancy and faced higher rates of maternal mortality. They were more likely to suffer from chronic conditions such as depression and substance abuse as a result of the trauma they experienced. They were less likely to retain control of their reproductive health. They were even more likely to consider and attempt suicide.
I simply could not accept these injustices. I couldn’t just observe all this and not act. I intuitively knew that the HIV & AIDS pandemic could not be brought under control unless this underlying issue was addressed. In fact, sexual violence against girls was impairing progress on five of the eight Millennium Development Goals (MDGs) at that time.
My intention was to raise the visibility of this problem so that an established health agency would mobilize a response. So, I met with the leaders of UNICEF, CDC, PEPFAR, UNAIDS and others. I described the problem and why it was so important. All expressed agreement and concern, but at the time, none of these organizations were ready to make this issue a central priority for their work.
So, consistent with my tendency to take personal responsibility, I decided to mobilize a new partnership to take on this challenging problem. At the 2009 Clinton Global Initiative (CGI) Annual Meeting in New York, President Bill Clinton announced and launched the new Partnership to Address Sexual Violence Against Girls, which soon after was renamed Together for Girls (TfG).
TfG: TfG was founded to address violence against children with a special focus on ending sexual violence against girls. Why the focus on adolescent girls?
Gary: TfG started with the singular focus on adolescent girls because of their inherent vulnerability to sexual violence and the devastating consequences that often follow. Much to my surprise, the gender-based violence programs that I identified at the time were focused on women, not girls. Furthermore, most of the service offerings for victims were only oriented towards women, despite the fact that over half of all incidents of sexual violence were being committed against girls aged 15 and younger. This struck me as a major gap that needed to be filled.
TfG: BD has extensive experience addressing a variety of public health issues. How did you identify that addressing sexual violence is a solution to alleviating other global health issues?
Gary: Typically, when the world responds to problems, it first focuses on treating the symptoms. For HIV & AIDS, it is essential to broadly extend treatment access, and the world is doing this at a cost of around $10 billion per year.
Next, focus usually shifts to establishing or improving the systems that inhibit or enhance the ability to treat the problem. For HIV & AIDS, this means strengthening healthcare delivery systems, laboratory systems, supply chain systems, procurement systems, and training systems; requiring a wide number of initiatives to facilitate access and delivery of treatment. This is all very important, but it doesn’t truly address the root of problem. It isn’t sufficient to focus only on symptoms and systems, the underlying causes must be addressed as well.
I call this third area of intervention social causes. All three of these “S’s” are essential: symptoms, systems and social causes. Ideally, we would address the social causes first, because doing so would substantially reduce the burden and the cost of improving systems and extending treatment for symptoms. But the world doesn’t work that way. We usually respond to crises, and HIV & AIDS wasn’t addressed until it was a full-blown crisis.
Back in 2009 when I founded TfG, very few people were talking about the health needs of adolescents, specifically about HIV prevalence rates in girls, in the health policy halls of Geneva, New York, Washington, D.C. or Seattle. Yet when I was meeting with people in villages in Africa, this problem was being talked about. We have come a long way. Today, adolescent health and HIV infection rates among girls and young women are in the center of the global health and development agenda. I guess I was a bit ahead of the curve on this issue.
TfG: How do the combined efforts of the private sector, national governments and multi-laterals ensure an integrated and effective response to eliminating sexual violence? What makes the TfG partnership unique in this respect?
The TfG model was built up from a simple concept from day one: if we can collaborate to plan and unite the individual efforts of different organizations working in this space, we can make the whole greater than the sum of the parts and end up with far greater impact.
At TfG, we are incredibly privileged to have many of the world’s most important and proficient agencies as partners–CDC, PEPFAR, USAID, UNICEF, UNAIDS, UNFPA, UN Women, and WHO–which allows us to have incredible reach and capability. If all these agencies work independently on this issue, the impact will be fragmented. TfG became the convener and orchestrator, and this enabled our work to extend from one to 23 countries in just ten years. That is what allows us to partner with national governments in all these countries and gain their commitment to combat violence against children, particularly sexual violence against girls.
Huge credit goes to the partners: to CDC for coordinating and leading the VACS surveys, to UNICEF for facilitating the in-country relationships, and to PEPFAR and Foreign Affairs Canada for their funding and evaluation support just to name a few. But the mobilization of our methodology and expansion to 23 countries would not have happened without the advocacy, fundraising and orchestration efforts of the TfG partnership as a whole.
TfG: What do you see as the biggest challenges and opportunities ahead in the next 10 years?
Gary: This issue, girls being abused and raped by men, isn’t going away anytime soon. It hasn’t existed only for the last ten years; it’s existed as long as human beings have existed and it will take a long time to change behaviors and mindsets. One of the biggest opportunities is the general awareness on this issue has shifted substantially over the past few years. The #MeToo movement has elevated awareness of sexual abuse, harassment and violence against women and girls. Girls are more empowered than they ever have been, and are much better positioned to defend their rights than anytime in the past.
Regarding challenges, well, I don’t think the world is in a particularly good place right now. The refugee crisis has triggered an explosion in the number of people who are living in vulnerable situations. Certain countries, particularly in the Latin American region where TfG is now working, have horrifically high rates of violence against children and gender-based violence. Unspeakable crimes are being committed, and girls who are among refugee populations are incredibly vulnerable, and so many countries are affected by this. I knew when I started TfG that this wasn’t a short-term issue. We will need to stay focused on it for many decades to come. And as such, one of the challenges is to ensure that the leadership and momentum of this effort remains strong. This is far too important to stop to take a breath; it requires continuous vigilance.
Yet after ten years of continuous effort, we can see so many things that have gone well, within a very diverse array of countries and cultures. That must give us the impetus and motivation to continue this essential work.
TfG: What are your proudest accomplishments from the past 10 years of the Together for Girls partnership?
A few things are remarkable in retrospect. First, at the outset of the partnership, we identified three main pillars of intervention which became the strategic, three-pronged model of TfG: Data, Action and Advocacy. These three components of TfG’s work are just as relevant today as they were at the start of the partnership. They have allowed us to build on work done in 2007 by CDC and UNICEF in one country, Swaziland (now Eswatini) and implement a consistent methodology in 23 countries throughout Africa, Asia, Central America, the Caribbean and Eastern Europe. Implementation of TfG’s data work consists of a national household survey interviewing children age 13 to young adults age 24 about their experiences with violence, particularly sexual violence, has enabled the TfG partnership to amass the world’s largest database on the experiences of violence among adolescents.
The second remarkable thing is I somehow led the partnership myself for the first 18 months, in addition to my regular ‘day job’ and multiple board responsibilities, before we recruited an exceptional full time Executive Director, Michele Moloney-Kitts. People told me I was crazy to try to lead a cross-sector partnership that included five UN agencies, the US government, and other partners. But somehow it worked well enough to get us off the ground and to ready TfG for Michele’s exceptional leadership, which was followed in 2016 by the exceptional leadership of our present CEO and Executive Director, Dr. Daniela Ligiero. They are among the most capable and highest integrity leaders I’ve ever known or worked with.
Overall, I find there is simply the general good feeling that comes with accomplishing something outside of one’s own area of training and expertise. I had no background in gender-based violence when I founded Together for Girls. What I did have is deep passion, common motives, effective facilitation skills and an annoying level of persistence.