It is time to tell the International AIDS Conference (IAC) organisers  that the lights are on… we can all see the dripping makeup, the creased and world weary visage, badly painted props and the torn seats we are so precariously perched upon. The tired old songs have been played one time to many.

Maybe I have been doing this for too long. Maybe AIDS fatigue is a real thing and I have succumbed to the narcolepsy after having to sit through the same show over and over again. The actors might change and the makeup and computer generated images (CGI) gets more sophisticated every year; but the script is still the same.

In the beginning, there was goodness and light and the world rose up to confront the challenges of HIV and AIDS. The emerging epidemic reshaped the development paradigm, reinvigorating the discourse around power and vulnerability, highlighting all that was wrong with the world: patriarchy; inequality; bigotry and a distorted world order. It refocused the agenda on Africa and its problems because, by this time, the rest of the world had become tired of ‘starving Africans’. They had seen too many images of famine and war and were starting to pay a lot of attention to fluffy polar bears and cute whales. HIV and AIDS gave us a reason to fight again for our humanity – or at least our sense of humanity.

And now nearly 30 years on, the HIV and AIDS industry is a reflection of all those things the development sector set out to challenge. No more so than in the ugly, bloated, resource consuming monster that the IAC is.

It is difficult to imagine a more apt physical manifestation of the distortions of power and influence that typify the sector than the physical layout of the Mexico City IAC. Let me paint the picture: the Global Village was separated from the main conference half; the Village surrounded, as it was, by a ‘moat’; people had to walk a distance to the main hall; and access to the main hall was strictly controlled. The physical layout reinforced the stark divide between the policy-makers and the implementers, between the developed and the developing world and between the influential and the influence-less.

It is also an indictment on the ‘consciousness’ of the sector that such vast amounts of resources are squandered in pursuit of ‘learning’. There was no new learning. Anything and everything that was said at the conference has been said before. All of the information and learning is freely available to people (and was mostly available in the run up to the conference) online and in the many, many information repositories that the sector creates and forgets. Our consciousness did not prick enough for us to relook at the carbon footprint of the event… flights, paper, plastic, traffic congestion, etc. It does not worry us that we rehash and recycle old debates and information and ignore the fact that we have heard it all before. It does not worry us that every two years people from all over the world come together to celebrate the fact that we have done nothing substantial in the period, except to prepare for the conference.

The hypocrisy of the glowing statements in support of PEPFAR II has to be commented on. Why, oh why, do we praise the incremental shift in policy that has no real tangible benefit for advancing a rights based agenda? PEPFAR II still preferentially supports abstinence programmes and provides limited support for condom programmes. The policy agenda of PEPFAR is inherently conservative. Yes, it is a lot of money and yes, we do need the money… but somebody, especially the vanguard of the UNAIDS, please have the balls to stand up and comment on all that is wrong with PEPFAR and not make it seem like George Bush just provided us with all of the answers to our prayers.

And what about Cambodia… what about the impact of anti-trafficking laws… what about a zero shift in patent protection … what about poaching of health professionals from developing countries… and what about…

I think we at least have to start asking the questions. What value does this conference and others like it, actually add to our work? Is the conference really worth it? Is it not time for us to consider doing it differently? Is it not time that we actually realise the sectors’ reputation for innovation and consider alternative (less costly, more effective, more honest) ways of sharing and learning?

And probably the biggest question for me is: Why the hell do people pitch up there and act so surprised by the things they hear? On which planet do they live? Are they really working in the sector? I can forgive the young and the naïve, but the vast majority of people at the conference should know better. Should know more.

So either we employ people in the sector who are very bad at their jobs or, like the grand dame of theatre that the IAC has become, we have been caught out when the lights are turned on.

* Not his real name. The writer, who works in development and attended the IAC in Mexico City, chose to use a pseudonym.