Dr Peter Piot opened the International Aids Conference in Barcelona on Sunday with a call to make politicians take the issue seriously.
Around 15,000 doctors, scientists, patients, politicians and charity workers have gathered in the city as the UN warns 68 million people could die from the disease by 2020.
Top of the agenda is a UNAids report suggesting the epidemic is still in its early stages and spreading fast.
"Let's bring forward the day when leaders who keep their promises on Aids are rewarded with our trust and those who don't, lose their jobs to those who will," Mr Piot said.
Michael Weinstein, head of the Aids Healthcare Foundation in the United States, said that, statistically, 50,000 people would die of the disease worldwide over the course of the six-day conference.
The conference will hear calls for the richer countries to do more to help the developing world to tackle the disease.
The World Health Organisation estimates that $10bn is needed annually to fight Aids. At present, just $3bn is spent.
Chaos feared
Dr Piot welcomed the fact that Aids was now on the agenda at world summits such as the G8 gathering of the richest nations.
But he said it was in the interest of every country, whether in the rich world or the developing world, to put Aids at the top of the political agenda.
"Ten billion dollars annually is all it will take for a minimum credible response to the epidemic," he said.
"We can't stand by when Aids is spreading in the most populated countries of the world, such as China, India, Indonesia and Bangladesh."
Dr Piot says one of the major challenges is to get Russia and China to recognise Aids as a key issue for their countries, before the disease reaches African levels of infection rates.
The situation in Africa - where 28.5 million people are living with HIV/Aids - will also be of great concern to the delegates.
Dr Piot believes much more needs to be done to tackle the disease there.
"The world stood by while Aids overwhelmed sub-Saharan Africa. Never again," he said.
Before the conference got under way, campaigners staged a protest to drug patent barriers which restrict the use of cheaper generic drugs for HIV/Aids patients in developing nations.