Twenty five years after the first Aids cases were reported, there is no sign of a halt to the pandemic which is likely to spread to every corner of the globe, the head of the United Nations' Aids agency has said.

Peter Piot was speaking as UNAids released a report which declares that the world's response to the disease that has infected about 65 million people and killed 25 million has been nowhere near adequate.

Five years after a special UN session pledged its commitment to halting the Aids pandemic, only a few countries have met the targets laid down.

"I think we will see a further globalisation of the epidemic spreading to every single corner of the planet," said Dr Piot. "It won't go away one fine day, and then we wake up and say, 'Oh, Aids is gone'. I think we have to start thinking about looking at the next generations. There's an increasing diversity in how the epidemic looks."

India has the largest number of people living with the virus. With 5.7m infections, it has overtaken South Africa's total of 5.5m. But the epidemic is still at its worst in sub-Saharan Africa, where 90% of the world's HIV-infected children live.

One in three pregnant women in South Africa tested HIV-positive in public antenatal clinics in 2004.

"I think in Africa, it is only comparable in demographic terms to the slave trade regarding the impact it has had on the population," Dr Piot said. "In southern Africa, HIV prevalence continues to go up, and they're already the world record."

The world is better prepared to deal with the pandemic than ever before, the report shows. Clear prevention strategies have been worked out, there is more funding, and drug treatment that can keep people alive - although not cure them - is slowly reaching those in the poorest countries.

By the end of last year, there were 1.3 million people in the developing world on antiretroviral drugs, averting between 250,000 and 350,000 deaths.

"We know what needs to be done to stop Aids," says the report. "What we need now is the will to get it done." It calls for "active and visible leadership" from heads of state and governments.

"Ultimately, it depends on how the leadership reacts, how the international community will continue to respond and how ready communities are to face the problem," Dr Piot said.

"Intervention is very low ... for many critical populations in many countries. We need to really intensify the response to Aids."

The report is launched on the eve of a high level meeting at the UN in New York to assess progress over the past five years and chart the way forward.

Most countries have a strong foundation on which to build an effective HIV/Aids response, the report says, but there are major weaknesses. Education and prevention programmes are failing to reach those at greatest risk and few pregnant women are receiving drug treatment in childbirth to stop them passing the virus to their baby.

Guardian Unlimited © Guardian Newspapers Limited 2006

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