A move made by the new South African President Jacob Zuma has led the world to question his government's health ministry's capabilities, after he appointed an obscure provincial politician to guide the nation through the world's worst HIV crisis.
Aaron Motsoaledi, a medical doctor currently serving as a provinicial education official, will take office as the new health minister Monday -- the second change in the post in less than a year.
The outgoing minister Barbara Hogan had won praise for breaking with the denialist policies of former president Thabo Mbeki and his health minister Manto Tshabala-Msimang, known as Dr Beetroot for shunning life-saving drugs for vegetables.
Zuma immediately sought to dispel concerns about the appointment, calling Motsoaledi "a well-known doctor who has handled this department at a provincial level in the past."
"He is a very energetic and able comrade so I don't think you should be very worried," Zuma added.
But activists warned that repeated changes in a ministry known for disorganisation would do little to focus the nation's efforts on easing the plight of the 5.7 million South Africans living with HIV.
"I have to say that it's very disappointing," said Mark Heywood, spokesman for the Treatment Action Campaign pressure group, noting that changes in leadership had also been made at the provincial level across the country.
"We have an entirely new political team responsible for health at a time where the health system is in critical need of rescucitation and in need of continuity and understanding."
Zuma carries heavy baggage into his fight against HIV. He's a polygamist in a country where multiple sex partners have pushed up infections and was number two under Mbeki, who caused long delays in the roll out of life-saving drugs.
But his biggest credibility challenge will be overcoming a 2006 bombshell while on trial for rape, for which he was acquitted, when he said he faced a small risk of infection in unprotected sex with his HIV positive accuser.
Zuma, who headed the country's national AIDS council at the time, went on to say that he had showered to minimise the chance of contracting the disease.
The much-ridiculed statements have haunted him ever since, despite an apology and his astonishing political come-back to the country's top office.
"Zuma's 'shower theory' has undermined his authority on HIV/AIDS and raised concerns about his capacity to effectively lead the government in the struggle against HIV/AIDS," said Elizabeth Mills of the University of Cape Town.
"Zuma has not demonstrated leadership with regards to sexual monogamy nor condom use," she added.
The new president has committed himself to strong AIDS messages but activists want visible leadership for a strong national response.
"I hope we will avoid destructive messages and controversies which detract from combating the HIV epidemic," said Laetitia Rispel of the Centre for Health Policy at the University of the Witwatersrand.
Another challenge will be finding cash to maintain the world's largest anti-retroviral drugs programme that had nearly 700,000 South Africans on treatment at the end of November.
The government plans to boost its battle by 932 million rand (112 million dollars) and double treatment over the next three years. But Zuma's team is facing the country's first recession in 17 years.
"I look forward to seeing how he translates rhetoric into practice as our new president. Time will tell," Mills said.
"Should Zuma prove us wrong in our cautious optimism, then South Africans will stand up together and fight until we are heard. We've done it before, and we'll do it again."