The clinical management of sexually transmitted diseases (STDs) in Russia has long been characterized by coercion and social control. A nationwide network of dermatovenereology clinics was established in the 1920s. Patients were required, by law, to disclose details of contacts and were subject to lengthy inpatient treatment and to long-term surveillance. In 1993 the Russian Ministry of Health issued a new order designed to reduce barriers to seeking care, in particular by improving the quality of care and enhancing confidentiality. One element was the establishment of clinics offering a degree of anonymity. We report a study combining a review of available literature, interviews with patients and physicians, and non-participant observation. This indicates that the concept of confidentiality is poorly understood among physicians and accorded little priority. It is, however, valued by patients and aspects of the system related to confidentiality act as barriers to access.