The International Aids Society conference has come and gone. Just like many other HIV and Aids conferences, the one recently held in South Africa was replete with numerous messages that challenged the work by NGOs and African governments in the fight against HIV and Aids.

The IAS is the world's independent association of HIV professionals, with over 14 000 members in 188 countries working at all levels of the global response to HIV and Aids.

Its members represent scientists, clinicians, public health, policy experts and community practitioners on the frontlines of the epidemic.

Of all the research, intense debates and arguments at the conference, a statement made by Dr Stefano Bertozzi of the National Institute for Public Health in Mexico was most striking.

Dr Stefano said: "We have been working towards more money for Aids, but I would argue we haven't done enough to ensure we are getting less Aids for the money."

I find his arguments valid, though not so popular with many in the HIV and Aids industry that have turned the disease into a "cash cow".

Despite remarkable growth in the available resources for HIV and Aids, there has been little attempt to measure the cost-effectiveness of interventions.

As the virus spreads, the HIV and Aids industry is also growing faster and bigger and yet the impact of this growth is not paralleled by results on the ground.

UNAIDS estimates that over 2,3 million people worldwide have died of HIV and Aids- related illnesses with 2,7 million new infections in 2008 alone.

Approximately 33 million people are living with the virus globally with sub-Saharan Africa bearing over 70 percent of the brunt. Over 25 million people had died of HIV and Aids-related illness by 2007.

Surprising over 25 years of huge spending on HIV and Aids has yielded nothing more than a big and complicated industry, which has become one of the most lucrative and fertile sources of donor income.

Whether the money reaches its intended target remains shrouded in the mystery and complexity of programme implementation. While Dr Bertozzi urged the HIV and Aids community to develop strategies to contain funding cuts and improve the efficiency spending, my augment is centred on the size and the overprioritisation of HIV and Aids as a stand-alone industry not closely linked to the wider public health delivery system.

The size of the industry has by far outstripped that of the public health, a foundation upon which the HIV and Aids industry must be rooted. While it is true that HIV and Aids has caused human suffering, it is still not a leading killer disease.

According to a recently launched report by WaterAid, diarrhoea kills more children than HIV and Aids, malaria and TB combined.

However, the diseases receive little financing and are not prioritised by governments in developing countries.

Governments seem to be sucked into the donor-driven humanitarian agenda at the expense of structural health development.

Reuters Alertnet, a humanitarian information network, places HIV and Aids second to lower respiratory infections, which account for more than four million deaths each year.

The majority of those who die from the respiratory infections are children under the age of five, while HIV and Aids-related deaths only account for only half that figure.What is of particular concern is that the HIV and Aids industry, which has emerged to tackle one disease has been allowed to grow into a gigantic and out of control stand-alone "business" without strengthening other areas of the health sector.

Roger England of Health Systems Workshop, a health-policy charity, states that "we have created a monster with too many vested interests and reputations at stake, too many single issue NGOs, too many relatively well-paid HIV staff in affected countries, and too many rock stars with HIV and Aids support as a fashion accessory".

The increased number of HIV and Aids NGOs and programmes is clear testimony to England's argument.

Most of the donor money on other health issues has been diverted towards HIV and Aids industry, which is known to be dominated by NGOs at the expense of more cost-effective health interventions usually run under government structures. Currently, HIV and Aids take more than a quarter of global health aid even though it causes only 5 percent of the burden of disease in poor and middle-income countries. Though England's arguments were received with a lot of resistance, it is my assertion that they carry a lot of weight taking into consideration what we have witnessed so far.

HIV and Aids is first and foremost a health problem whose effective response depends on a public health delivery system with good infrastructure and a strong human resource base.

In many sub-Saharan countries, the governments carry this responsibility to ensure the availability of the infrastructure and adequate and skilled health professionals to ensure all health issues including HIV and Aids are professionally managed.

The Aids industry has created parallel financing, employment and organisational structures; weakening national health systems at a crucial time and sidelining needed structural reform. While the HIV and Aids industry is bubbling with money, Third World governments are struggling to maintain their health infrastructure and keep skilled health staff who are lured by better paying jobs elsewhere.

This narrow replication approach ignores the fact that a meaningful and effective response to any health problem depends on strong health delivery system.

It serves no purpose to blame poorly resourced governments for not putting in place strong health delivery systems when huge sums of funding earmarked for HIV and Aids provides no incentives for countries to create sustainable systems undermining sensible public health reforms and perpetuating dependency on aid.

Many Third World governments have made it clear that funds are not needed particularly for HIV and Aids, but to strengthen national health systems in order for them to holistically deal with all types of health problems in their countries.

Sadly, this message seems to fall on deaf ears as the development partners insist on their favourite and fashionable health problems.

As long as the Aids industry remains the way it is, the health delivery systems for Third World countries will remain weak, unable to meet not only the HIV and Aids requirements but the general public health system.

Michael Gomo is a development communication expert. He has worked as a humanitarian communicator for almost a decade with international development agencies in Zimbabwe and Southern Africa.