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Those differences have played out in ways both dramatic and small during the special session, which began here on Monday. 

Twenty years after AIDS first began to take its toll, officials could not agree on which groups they should even proclaim at risk. Because of objections by Islamic delegates, debate continued over whether to mention gays and prostitutes — groups long acknowledged to have been hit hardest by the disease — in the official declaration. A draft of the declaration, scheduled for a General Assembly vote on Wednesday, urges all countries to protect the rights of people with AIDS. 

At the outset, the special assembly was sidetracked with a lengthy and acrimonious debate over whether a representative from a gay group should be permitted to participate in a roundtable discussion (nearly a dozen assembly members opposed it, with a Malaysian delegate openly condemning the eventual decision to include the representative). 

Outside the assembly's formal sessions, small conference rooms are filled with accounts of the devastation of AIDS around the world, the underlying causes of its spread in certain countries and the implied competing interests over how a proposed $9 billion pot of new money to fight AIDS globally will be distributed.

Indeed, while the official debate has centered largely around the cost of AIDS drugs and their availability, most people outside the official delegations are more concerned with addressing the basic problems that have contributed to or resulted from AIDS: a lack of even rudimentary health clinics in districts of Nepal where thousands have died from diarrhea; grandmothers in Uganda who have no income and are raising a half dozen orphans, many of them infected with AIDS; widespread starvation in various African villages where everyone who used to farm the crops is either dead or sick. 

"There has been an overemphasis in this conference about drugs," said Vijay Rajkumar, a Nepal-based AIDS adviser for Save the Children. "The lack of drinking water is a much bigger priority in most countries than anti-retroviral treatments."

The wide chasm between those who write policies and pay for programs and those who have to make them work on the ground is as old as the international development field itself. But the stakes have never been as high: AIDS has killed nearly 22 million people worldwide, and infection rates are rising rapidly in many countries.

This session, the first that the United Nations has devoted to a health care subject, has made it clear that stemming AIDS requires complex and sensitive strategies that vary greatly from country to country, perhaps frustrating Secretary General Kofi Annan's plea to "combine leadership, partnership and solidarity." 

What to do about Mauritania, for instance, where condoms are all but illegal? What about rural Kenya, where the practice of passing wives down from one infected brother to another is common in some villages with high illiteracy among women? "We are looking for solutions like everyone else," said Jane Mumbi Kiano, who represents the National Council of Women of Kenya. "You have all kinds of posters but some of our women cannot read or write. We are very concerned about this global fund."

The clashes among cultures became evident on the first day of the session. Besides the scuffle over the representative from the gay group, trouble immediately erupted when the official delegation began its central task of working out a universal "declaration of commitment" on the fight against AIDS. 

Some Islamic countries quickly objected because a draft of the declaration included gays and prostitutes in the groups of people particularly at risk for contracting the disease. 

The issue created heat in the hallways and in the Café Vienna, the smoke-filled cafeteria where visitors deconstruct the day's events. 

A woman with a large floppy hat who identified herself simply as Pamela carried around a sign condemning the exclusion of sex workers from the proposed declaration. Equally concerned was Roma Debabrata, who runs an organization in India to stop the sexual trafficking of women and children.

 "The language is a problem," Ms. Debabrata said. "You must be absolutely clear, with no side tracking about who needs intervention in this draft."

And while some groups drew controversy, others seem to have been largely ignored. For instance, when most health organizations tally up those who are most at risk for AIDS, they tend to identify sexually active people as those under 49 years. Safe- sex literature tends to be written for younger people and distributed in places where they congregate. 

"People over 50 are not considered sexual beings," said Paul Godfred, a training adviser from HelpAge International, citing a town in Thailand where 394 people out of 4,000 with H.I.V., the virus that causes AIDS, are over 60. Mr. Godfred recalled an education session for older people in India where the group addressed asked for condoms. Confused but agreeable, the AIDS worker brought a basket the next day, and they immediately disappeared.

Death is often only the beginning of the problems for communities in some of the world's poorest nations, especially the elderly. In much of Asia and Africa, the elderly are often left to care for their grandchildren orphaned by AIDS, without the financial support of their own children, now dead, that they had counted on all their lives. Many are widowed and with few resources. Livestock is often sold to pay for medications and funerals. When children die, government subsidies to care for them end too.

AIDS has also created other public health problems that require vast resources, like widespread hunger among the rural poor. The United Nation's Food and Agriculture Organization estimates that roughly seven million agricultural workers with AIDS have died since the mid- 1980's, leaving hunger and economic devastation; in Kenya, for instance, between 49 percent and 78 percent of household income is lost when one person with AIDS dies. 

Poverty in rural areas in turn leads to the spread of H.I.V., as men seek work in cities and contract the virus and women turn to prostitution themselves as a means of income. Prevention messages, an area where much AIDS money is spent, are often inconsistent with the way people live. "The rural poor are impervious to traditional prevention methods," said Gary Howe, the director of the International Fund for Agricultural Development in the East and Southern African division. 

In official speeches from the delegates, there is vague language about cultural sensitivity in safe-sex literature. But the causes of the spread of AIDS are often so specific to a particular country that they defy any global solution. 

In Kenya, wife inheritance and genital mutilation with shared needles has been a contributing factor, said Ida B. Odinga, from that nation's League of Women Voters. Mali Bent Sidi, a women's rights worker in Mauritania, described how the sharing of needles to pierce children's ears had contributed to the spread of AIDS, as well as an almost official ban on condoms. 

Many groups said that discussions about anti-retroviral drugs was highly irrelevant in many areas where there are no clinics to distribute them, no clean water or food to take them with and a lack of even basic antibiotics to stave off the less onerous infections that stem from H.I.V. 

All of these concerns need money, and many of the nongovernment groups feared that the new money that world leaders have called for to stop AIDS will get sucked up by administrative costs, corrupt governments and the single area of AIDS drugs. "I fear that a major chunk of the global health fund will go to drugs," said Mr. Rajkumar, of Nepal. "And that means money for drug companies and not for infrastructure."

Using local groups familiar with the problems of their region is a long- held practice by the United Nations, but many fear that the flow of money will not come their way. "International AIDS agencies have come with money before and it all goes to overhead and not where it belongs," said Pearl Nswahili, founder of STOP AIDS in Nigeria. "This meeting has huge talk but not a lot of action.

"There are lots of documents," she added, but "we still don't have any condoms."