In a few days Toronto will be overwhelmed by thousands of visitors, gathering for the International AIDS Conference. Once an annual confab, the AIDS conference now convenes every two years—a sufficient passage of time to make the meetings markers of the history of this hideous pandemic. History will probably note that the 2006 Toronto meeting of 24,000 people was an upbeat affair. Statisticians will say that the pandemic has reached a global plateau, and is declining in many countries. We will hear that some 1.5 million to 2 million people living in desperately poor countries are now getting daily doses of anti-HIV medicines, thanks to a multi-billion dollar global funding effort that comes from sources as diverse as Bill Gates, rock star Bono, the G-8 governments and the World Bank. A mantra will be repeated many times: “We want universal access,” to the anti-HIV drugs. Promises will be made. Some may even, eventually, be met.The question is whether, 10 years from now, the Toronto conference will be marked as the beginning of the end of AIDS, or a time of widespread Pollyannaism.