His final point was that multilateral organizations are essential to real success. While most of his comments have focused on the U.S. response to HIV/AIDS, it is important to recognize that every U.S. dollar contributed to the Global Fund leverages an additional $2 for most other European donors. In addition, multilateral aid is not subject to what he termed “the beltway tax” or the high overhead rates that prevent important money from reaching the ground where it is most needed. He identified a small multilateral vehicle that has been addressing the prevention of violence against women for the last decade—the United Nations Development Fund for Women (UNIFEM). The United States has increased its contributions to $1.8 million of the $1 billion UNIFEM budget. He did articulate support for the recommendation to create an agency for women as part of the United Nations, which Stephen Lewis mentioned as a possibility for an appropriate multilateral mechanism. If this recommended agency does not evolve, he suggested that people should support the UNIFEM to become a major multilateral mechanism that can leverage money from the rest of the world.
In response to questions from the audience, Gartner pointed out that addressing violence, like other issues in global health, is not only an issue of compassion, but also clearly one of national security. India, Russia, and China—all countries with rising HIV rates and climbing rates of violence—are nuclear powers. He stated that we are risking state failure in many countries of sub-Saharan Africa, with the possibilities of future civil conflicts and the alarming and escalating numbers of children who will be orphaned in many southern African nations. Recent events have shown that drug-resistant tuberculosis can cross borders quickly. All of these examples and many others point to the health dimensions that link violence to issues directly related to the security of the United States.
When asked about the usefulness and impact of reports from the Institute of Medicine (IOM) for influencing Congress and the administration, he identified the IOM’s recently released report PEPFAR Implementation: Progress and Promise (IOM, 2007; available at http://www.nap.edu/) as being enormously helpful in the HIV/AIDS community’s efforts to remove budgetary allocations from the U.S. Global AIDS Initiative’s legislation that are affecting the effectiveness of U.S. prevention policy in the program. He also stated that he thought an IOM report (a consensus study) would be helpful in catalyzing the operational and policy definitions for what could constitute scientifically sound violence prevention interventions, as well as linking together the issues that need to be addressed.