MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care in most localities is below Western standards; shortages of medical supplies, differing practice standards, variable specialty training opportunities and the lack of comprehensive primary care all combine to make the medical system difficult to negotiate as well as suspect. The few "quality" facilities in Moscow and St. Petersburg that approach acceptable standards do not necessarily accept all cases (i.e., they may not be licensed to treat trauma, infectious disease or maternity cases). Access to these facilities usually requires cash or credit card payment at western rates upon admission.

Elderly travelers and those with existing health problems may be at particular risk. Elective surgery requiring blood transfusions and non-essential blood transfusions are not recommended, due to uncertainties surrounding the local blood supply. Most hospitals and clinics in major urban areas have adopted the use of disposable syringes as standard practice; however, travelers to remote regions should bring a supply of sterile, disposable syringes and corresponding IV supplies for eventualities. Travelers should refrain from visiting tattoo parlors or piercing services due to the risk of infection.

Outbreaks of diphtheria have been reported throughout the country, even in large cities such as Moscow and St. Petersburg. The U.S. Centers for Disease Control and Prevention recommend up-to-date diphtheria immunizations before traveling to Russia and neighboring countries. Typhoid can be a concern for those who plan to travel extensively in the region. Cases of cholera have also been reported throughout the area. Drinking bottled water can reduce the risk of exposure to cholera and other infectious and noxious agents. Tap water in Russia, outside of Moscow, is generally considered unsafe to drink. Travelers are strongly urged to use bottled water for drinking and food preparation.

Rates of HIV infection have risen markedly in recent years. While most prevalent among intravenous drug users, prostitutes, and their clients, the HIV/AIDS rate in the general population is increasing. Reported cases of syphilis are much higher than in the U.S., and some sources suggest that gonorrhea and chlamydia are also more prevalent than in Western Europe or the U.S. Travelers should be aware of the related health and legal risks and take all appropriate measures.

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention's hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC's Internet site at http://www.cdc.gov/travel. For information about outbreaks of infectious diseases abroad consult the World Health Organization's (WHO) website at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith.