“AIDS unleashes a chain of events that threatens to cause entire societies to unravel,” UN Secretary-General Kofi Annan says in the report. “In short, AIDS is an exceptional problem which demands an exceptional response.”

More than 120 delegates were scheduled to address the all-day meeting yesterday, many of them ministers or their deputies, to assess progress since a 2001 special UN General Assembly session on HIV/AIDS.

Programmes have succeeded in Brazil, which has the most successful AIDS programme among developing states.

Cambodia and Thailand have shown substantial progress and several African countries, as well as the Bahamas, have slowed rates of infection, says the report Annan submitted to delegates yesterday.

But only 12% of those who need treatment are receiving it.

Effective prevention programmes, counseling and testing services are the exception to the rule and drugs still cost too much, the report says.

But despite the many programmes and money spent, the pandemic has not been reversed. The 4,9-million infections and 3,1-million AIDS deaths in 2004 are the highest to date, Annan says.

Some of the worst predictions have come to pass. Nearly half of the estimated 39,4-million people living with HIV, the virus that causes AIDS, are women and girls, whether married or single.

“The trend is that more young women are being infected than young men,” Thoraya Obeid, the head of the UN Population Fund, said this week.

“If they are married, they can’t abstain,” Obeid said.

Women, she said, needed information, including how to use a female condom to protect themselves. Men and women between 15 and 24 years old were the hardest hit.

Obeid released a survey done by young people in a dozen countries, most of whom said they had no voice in their country’s AIDS policies.

Others said programmes needed to be comprehensive — abstinence and sex education, young people talking to other adolescents, as well as to intravenous drug users.

The world’s largest donor for fighting HIV/AIDS is the US, which spent $2,4bn last year. But it is being urged by conservative religious groups towards abstinence-only programmes and away from vulnerable groups such as prostitutes, homosexuals and drug addicts.

Included in the US contribution is about $450m, or a third of the budget of the Global Fund to Fight AIDS, Tuberculosis and Malaria — a powerful independent body first proposed by Annan four years ago.

The new head of the group’s policy and strategy committee is Randall Tobias, who runs the Bush administration’s AIDS programme. Some officials are worried that the fund will adopt US positions, but others say such fear is groundless.

Worldwide, the UN report says, about $8bn will be available this year to implement programmes in 135 low- and middle-income countries, a dramatic 23% increase over the previous year. Of this amount, rich countries have contributed about $6,7bn, six times greater than the world spent in 2001.