TORONTO — You definitely see and hear it all at an international AIDS conference. But amid the cacophony, some constructive voices can still be identified.

The 24,000 conferees at the weeklong conference that ended Friday here all want to be visible and vocal — as do some who aren't even here. On Aug. 13, for example, Robert Gallo, co-discoverer of the AIDS virus back in the 1980s, was quoted on the front page of The Toronto Star as saying that the conference was "irrelevant" and "silly."

He added that if it takes celebrity star power (Richard Gere, Alicia Keys) to get people to come to such a conference, "then you've got the wrong people coming."

Needless to say, Gallo wasn't here, and he wasn't invited.

Others were here, offering even more criticism. Stephen Lewis, a longtime fixture on the left wing of Canadian politics, has managed to secure himself a gig as the United Nations' special envoy for AIDS in Africa. But he seems to spend most of his time not in Africa, but lecturing Western governments about their shortcomings.

It's hard to imagine that Lewis is helping Africa by bashing the big donor countries, especially when he doesn't even have his facts straight.

On Wednesday he decried President Bush's pro-abstinence policies, describing them as "incipient neo-colonialism." Never mind that abstinence is just one aspect of American policy; the Bush administration is also the leading funder of condom distribution programs worldwide, having paid for more than 2 billion of them.

Such political posturing doesn't help. What does help is a relentless focus on the real problems, and on that score, it's possible to learn a lot by listening, as opposed to talking.

Perhaps the most impassioned and persuasive speaker I heard here was Dr. Richard Horton, editor of The Lancet, the London-based medical journal.

Decrying the "complacency" he sees creeping into these proceedings — including the complacency of giving the same speeches over and over again, conference after conference — Horton noted that one of the biggest problems for world public health is coming as an unintended consequence of AIDS spending: namely, the diverting of expertise from other healthcare fields.

"We need 1 million more health workers in southern Africa," Horton declared, noting that the gusher of AIDS money has pulled workers away from other vital areas, without increasing the overall labor supply.

"It's not HIV versus malaria and TB," he insisted. "It's HIV and malaria and TB."

A similar point was made by Laurie Garrett, who, while at Newsday won a Pulitzer Prize for writing on infectious diseases, including AIDS, before becoming a fellow at the Council on Foreign Relations in New York. Garrett told me that the economics of foreign aid are such that if a "healthcare worker" becomes an "AIDS worker," he or she will enjoy a tenfold pay raise, because of all the money pouring in. But the problem, of course, is that other killers, such as the diarrhea that comes from poor sanitation and hygiene, are now shunted aside by the AIDS rush.

There are other problems, too, that are worth learning about — and doing something about. Africa consists of 53 countries; that's 53 different regulatory systems, 53 different opportunities for Murphy's Law, and 53 different honey pots for possible corruption. Clearly, some sort of rethinking of multilateral aid structures, by recipients as well as donors, is called for.

Yet amid all this need, there's no shortage of mindless knee-jerk stridency.

At one panel discussion hosted by a nongovernmental organization called World Growth, a questioner from the audience addressed a drug company official and demanded, "Just give the products away!"

Here's a better plan: Guided by a spirit of realistic compassion, people should convene to consider what is and is not working on AIDS, putting aside their bile and bias. Some of that is happening here — more than one might have thought. And that gives us hope.

James P. Pinkerton is a columnist for Newsday.