Interview to Mario Raviglione as the Global Health Centre Director, University of Milan

The Global Health Centre - GHC, a founding component of the new MACH (MultidisciplinAry ResearCh in Health Science) of the University of Milan established with the support of the Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, is the first of its kind in Italy as it merges didactics and research towards “ensuring healthy lives and promoting well-being for all at all ages” (the United Nations’ Sustainable Development Goal 3 target). It aims at becoming a comprehensive and impactful contributor to the global health discussion internationally.


The GHC is directed by Professor Mario Raviglione. Find here a PEAH interview to him.

 Professor Mario Raviglione*

It is through the education of future decision-makers and leaders that health and access to it will be prioritized in every sector when choices are made. To put it in simple words, we aim at building ‘health-sensitive’ young generations of professionals

Interview

 

Professor Raviglione, the Global Health Centre – GHC is a founding component of the new Centre for MultidisciplinAry ResearCh in Health Science (MACH) and inspires its visionary aims. In this connection, can you tell us more about the MACH?

The new Centre for MultidisciplinAry ResearCh in Health Science (MACH), devoted to the sciences related to the health of populations, established in 2019 at the University of Milan, aims at becoming an international landmark and leading centre for health research. The special interest in infectious diseases, given the background of most of his founders, is complemented by that towards emerging global health threats, including non-communicable diseases, all seen through a global, equitable and multi-disciplinary perspective.

The Institute researchers tackle global health challenges, such as those determining illness and suffering among the poorest and marginalised populations, as well as those that can be faced through innovative biomedical solutions from research in immunology and microbiology. The MACH is truly a brand-new model of collaborative research in our country created with the support of the Fondazione IRCSS Ca’ Granda Ospedale Maggiore Policlinico that will offer its premises to host it.

Back now to GHC and its broad vision

GHC is engaged in addressing the principles and scope of global health, facing inequities and aiming at improving access to “health for all” through didactic and research activities conducted in partnership with experts from other national and international centres and institutes, nationally and internationally, sharing similar.

As for GHC’s ultimate goal?

GHC’s ultimate goal is to contribute to the development and implementation across disciplines, in full alignment with the United Nations Sustainable Development Goals (SDGs) 2016-2030, of sound health policies and practices that ensure universal access to care and prevention for the most vulnerable people in Italy and the world. To achieve this, multidisciplinary research and education engaging young generations of students that will become future leaders and decision-makers are essential. The GHC has therefore some basic functions.

Which are these functions?

The GHC has two clear-cut and well-defined functions. The first is Training and Education in global health: to create a cadre of future passionate leaders capable of being “global health-sensitive” among committed students from different backgrounds, including biomedical sciences, economics, law, international relations, sociology, ecology,  agronomy and all other related fields. As part of this programme, at University of Milan teaching on the essentials of global health is now integrated as a module into the regular medical student curriculum, a unique situation in Europe. In 2019-20, we will also begin teaching the principles of global health to students of other non-medical faculties.  The other real innovation is a new 1-year post-graduate Master Specialty Course in Global Health tht will start in late 2019 in collaboration with experts from prestigious academic institutions nationally and abroad. This is the very first in Italy and one of the few available in Europe. The second is Research to contribute to identification of innovative ways of handling complex public health problems looking at research as a continuum from the laboratory and fundamental research to operational and policy-related investigations.

In addition, two other functions derived from the main two include (i) contribution to making health policies focusing on that evidence generation that influences policy making by health authorities; and (ii) health promotion and advocacy to pursue public awareness and understanding of global health values and healthy behaviours through students towards civil society.

Kindly, add details relevant to the under-graduate module in Global Health and the coming post-graduate Master Course in Global Health

As mentioned above, the GHC staff has introduced teaching in global health for under-graduate students at University of Milan by integrating it into the regular medical student curriculum; second, the new Master Course in Global Health has been established for those who want to pursue a career in global health. Both are coordinated by myself in close collaboration with the team of Professor Andrea Gori. The under-graduate teaching – the first of its kind in Italy and an innovation in Europe – consists of a module, that is adapted to the level of students, focused on the essential knowledge of the big themes of global health as part of the mandatory courses of Public Health and of Introduction to Medicine in the Medical School curriculum. In essence, we teach to first-year medical school students as well as to those in their 2nd, 4th and 5th year enrolled in the course of Public Health (and Hygiene, as it is often still called in Italy). As of  2019-20, we will also start teaching the principles of global health to economics and management students, as I do already at the health management course at Bocconi University. This is an attempt to make other future professionals more “health-sensitive”, so that one can count on their understanding of the concepts of universal access, vulnerability, social and economic determinants, etc when making general policies in the future. It intends to address the fact that health is the result of choices made in many other sectors beside the biomedical one.

As for the Master Course in Global Health (MGH), organised by us at GHC through a joint initiative with colleagues at MACH led by Prof. Gori and with the precious collaboration of Giulia Rolla, and financially supported also by Intesa SanPaolo, it is a professional, specialty master of 1-year duration offered by the University of Milan in close collaboration with experts from major institutions world-wide, including University of Geneva, Karolinska Instituten, Columbia University, Graduate Institute Geneva, Swiss Tropical Medicine Institute, World Health Organization and others such as San Raffaele Hospital, Niguarda Hospital, University of Brescia, University of Sassari, Bocconi University, CUAMM etc. The first year will begin in early November 2019 and end a year later. In a few words, the new master course aims to deepen knowledge and study contemporary global health issues from an interdisciplinary and inter-sectorial perspective. The MGH, conducted in English language, is open to post-graduate students from Italy and abroad coming from a variety of different backgrounds: from health and biomedical sciences to economics, sociology, anthropology, international relations, law, ecology, agronomy, diplomacy, political sciences, management etc. The MGH mission is to provide students the toolbox to understand and analyse health issues with a focus on both their broader determinants and direct causes, while looking for innovative solutions that transcend sectors. The Master aims to prepare students and future leaders to work in different settings that include the public sector at national (e.g. ministries of health, foreign affairs, development cooperation, etc.) or local level (e.g. regional or district public health authorities), international organizations, nongovernmental and faith-based organizations active in health and development, public private partnerships, and the private sector engaged in health.

Will students have the opportunity to go outside of the school class and see the realities of the world today when it comes to the way of managing global health issues?

Certainly! The Master Course will include a week of simulations of monitoring and support visits to high-disease burden countries, led by the team of Prof. G.B Migliori of the WHO Collaborating Centre based at Fondazione Maugeri, Tradate, Italy, and conducted in the peaceful Valtellina mountains, in a sort of retreat format. Further, the master course will allow students to rotate through major institutions in Milan, such as Niguarda and San Raffaele Hospitals, and learn the significance and applications of modern “omics”, so that they are ready to face ethical and technological issues. And, very importantly, the master course includes a rotation of one month for all students to low-income settings of Africa such as Cameroun, thanks to a collaboration with the national government through the University of Geneva, and Pemba, in the U.R. of Tanzania, also thanks to the collaboration with the local government through the Fondazione Ivo De Carneri, Milan, Italy.

Eventually, what about global health research at the GHC?

Global health research is an ongoing programme that explores innovative ways of handling complex public health problems, embracing innovations in technology and epidemiological understanding, and exploring implementation challenges. The programme works with experts from partner institutions in Italy and world-wide and focuses on priority conditions in infectious diseases and beyond, determinants of health, and innovations in delivery of care and prevention. GHC priorities in global health research include:

  • Innovations and new technologies in the response to major killers like tuberculosis and HIV
  • Poverty, migration and vulnerability as socio-economic determinants of access to health
  • Translation of technological advances into policy and practice

In concrete terms, I am working now on projects related to migrant health issues, the definition of “precision global health “, which is a new concept under development by important global health experts in Europe, policies for new drug development for which we have a grant from the European Union, and some specific challenges in the global fight against tuberculosis, that is my old passion and area of expertise.

Thank you Professor Raviglione for your enlightening answers and highly commendable engagement

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* About Professor Mario Raviglione

Mario Raviglione graduated from the University of Turin and specialised in the USA (Cabrini Medical Centre, NY, and Beth Israel Hospital at Harvard Medical School, Boston) in internal medicine, infectious diseases and AIDS. He was director of the Global Tuberculosis Programme at the World Health Organization, Geneva, between 2003 and 2017. He is Full Professor in Global Health and Director, Global Health Centre, at the University of Milan and holds the appointment of Professeur Titulaire at the Global Studies Institute of the University of Geneva, Switzerland.

Contact: mario.raviglione@unimi.it

 

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Expanding Access to Rights Documentation: Tools for Marginalized Groups in Myanmar

This article explores how nonprofit Asia Catalyst implemented a rights-training program for community-based organizations (CBOs) in Myanmar and the positive outcomes of these collaborations. The three CBO partners discussed represent heavily marginalized groups in Myanmar: people who use drugs, people living with HIV, and sex workers.  Through this program, Asia Catalyst taught rights-driven approaches to gathering data in interviews, which has helped the groups sharpen and enhance their advocacy skills, which in turn has enabled them to effectuate positive change

 By Julia K. Klein, J.D.

Duke University School of Law, J.D.

Vanderbilt University, B.A., cum laude

julia.k.klein@duke.edu

Duke Law International Human Rights Clinic

Expanding Access to Rights Documentation: Tools for Marginalized Groups in Myanmar

 

Asia Catalyst is a nonprofit organization empowering community-based organizations (CBOs) with tools and resources to help them become more effective in human rights documentation and advocacy, which strengthens organizations’ ability to function democratically, sustainably, and more effectively cater to the needs of their communities. We have worked domestically, nationally, and internationally to empower hundreds of civil society groups across Asia, primarily in China and Southeast Asia, since 2006.  We began working concertedly in Myanmar in 2015 with our Regional Rights Training (RRT) program, which also included Viet Nam, Cambodia, and China.  The RRT program focused on strengthening CBOs through workshops on topics such as a rights-driven approach to data collection and documentation, regional coalition-building of like-minded organizations, publications of comprehensive reports highlighting findings and policy recommendations, and customized advocacy support to assist in implementation of rights-based advocacy projects for each of the participating groups.   In 2017, Asia Catalyst established a country program in Myanmar to focus on continued rights training demand from local CBOs following our successful RRT engagement. Through this new Human Rights Documentation and Advocacy Project in Myanmar, CBOs are guided through the rights framework and identify priority issues to document and create an evidence base for policy advocacy and coalition building.

Myanmar has undergone widespread changes in government and expansion of civil liberties since November 2010, when the long-ruling military junta was replaced by a military-backed civilian government.[1]  Accompanying changes such as the revival of democracy, the installation of a human rights commission, and the advent of legalized demonstrations in Myanmar are the collective efforts of government, nongovernmental organizations (NGOs), intergovernmental organizations (IGOs), and international nongovernmental organizations (INGOs) to improve access to healthcare for marginalized groups, such as people who use drugs and people living with HIV.  Focus in Myanmar on these areas is crucial.  Myanmar has the second highest HIV prevalence in Southeast Asia after Thailand,[2] with an estimated prevalence of 0.7% of adults living with HIV.[3] Myanmar is one of 35 countries accounting for 90% of new cases of HIV.  Illicit drug use is pervasive, with an estimated 83,000 people using opium or heroin in Myanmar.  HIV prevalence among people who inject drugs is 34.9%.  Among sex workers, another stigmatized group, 5.4% have acquired HIV.[4]  Given these alarming statistics, and in line with global health and development goals, in 2017, Myanmar pledged to end HIV as a public health threat by 2030 through a robust educational program and universal access to prevention, treatment, and care.[5]  The Myanmar government also plans to achieve ambitious 90-90-90 targets.[6] The 90-90-90 target means 90% of people living with HIV know their status, 90% of people who know they are living with HIV have access to treatment, and 90% of people in treatment have successfully suppressed viral loads.[7] Myanmar aims to complete the 90-90-90 plan by 2020.[8]

Accurate data on people living with or at high risk of HIV is essential for governments in order to address epidemics, yet criminalized groups are frequently denied, ignored, or invisible in national statistics and data collection efforts. Understanding HIV among key populations,[9] such as people who use drugs and sex workers, is essential for the appropriate design of and access to effective prevention and treatment programs.

To promote vital data collection by and for communities and to promote effective government advocacy from findings, we implemented workshops designed to expand the ability of CBOs to document rights abuses, contribute to the local evidence base, and advocate for their rights more effectively. This article highlights two recent examples from our program. The first describes documentation and advocacy by women living with HIV and sex workers, on access to healthcare including sexual and reproductive services. The second describes community-led data collection by people who use drugs on the impact of recent closures of harm reduction[10] drop-in centers (DICs) in Yangon, Myanmar’s largest city.

Rights-Based Data Collection on Accessing Reproductive Healthcare for Women Living with HIV and Sex Workers and Subsequent Advocacy

A core component of our rights training program includes building documentation skills to generate local evidence for advocacy. We worked with Myanmar Positive Women’s Network (MPWN) and Right to Health Action Myanmar (RHAM) to design and implement research on their communities’ priority concerns. For RHAM, this was access to sexual and reproductive health services for sex workers. For MPWN, this was collecting rights-focused data about sex workers’ experiences accessing health services at government healthcare facilities in Yangon. MPWN is a country-wide organization dedicated to empowering women living with HIV through training them to advocate for themselves to meet health, economic, and social needs.  RHAM is a Yangon-based CBO focused on improving access to sexual and reproductive health services for sex workers as well as fighting for improvement of policies that lead to discrimination and violence against sex workers.  It is imperative to address the issues facing these groups because 5.4% of sex workers[11] and 0.7% of women aged 15 and over are currently living with HIV.[12]

Overall, women living with HIV reported negative experiences in accessing treatment because of harassment from medical professionals and staff, public exposure of their HIV status, and addition of unnecessary treatment costs. In general, the interviewees reported feeling comfortable accessing healthcare at National Aids Program treatment centers. Interviewees reported easy access to condoms, but some sex workers stated access was harder due to discrimination from doctors and fear that their occupation would be disclosed to their families and neighbors. However, interviewees reported having very little information about preventing HIV transmission during pregnancy and childbirth.  Some women reported being shamed by healthcare workers for getting pregnant, and they were not provided meaningful education on how to have a healthy pregnancy with HIV. One interviewee reported forced sterilization.  Some reported further stigmatization because they were also sex workers. Stigmatization sometimes took the form of having to pay additional fees, such as cleaning costs and additional bedsheets, when non-sex workers did not have to.  Many respondents reported emotional distress when medical providers or staff disclosed their HIV status publicly. One interviewee stated that she “was traumatized mentally. Because of them, my family knows that I am HIV-positive and I faced a lot of family problems. The lab technician told my result to my mother-in-law.  My mother-in-law shouted at me in front of others, ‘you are a prostitute. That’s why you got HIV. You deserve this.’”

The data gleaned from these interviews helped the CBOs construct recommendations to township-level National AIDS Program team leaders about the needs and requests of sex workers in Myanmar. It also enabled the development of recommendations, such as nondiscrimination training of medical staff and doctors, by women living with HIV to the National Aids Program, INGOs, IGOs, NGOs, and the Ministry of Health and Sports.

Community-Oriented Data Collection on the Impact of Drop-in Centers for and Their Closures for People Who Use Drugs

We worked with five CBOs of people who use drugs in Myanmar to understand their human rights and document barriers to evidence-based harm reduction services.  It is crucial to work with this population because the Myanmar government chooses to address the epidemic, an estimated 83,000 people who inject drugs, through prison sentences and other punitive approaches by which numerous rights are violated.[13]

The example below provides results from documentation by Youth Empowerment Team (YET),  a Yangon-based organization run by young people who have drug use experience.  YET focuses on harm reduction programs and is dispelling the notion that harm reduction is equivalent to encouraging drug use.  Below, we report on community research methodology and findings as reported by YET.

YET trained four peer educators who interviewed 27 people who use drugs about access to harm reduction drop-in centers, where participants receive services such as methadone therapy, condoms, harm reduction techniques, clean injecting equipment, and referrals to methadone treatment centers and places where they could receive naloxone, which is administered to reverse opioid overdose. Interviewees reported feeling comfortable and welcomed at DICs, perhaps because they are partially run by peer drug users and did not experience as much shaming. They emphasized how crucial methadone is to their recovery and well-being.  One interviewee stated “because of methadone therapy I can concentrate more on my work.”

By October 2017, many of these DICs were forced to close due to a lack of funding. This was devasting for people who use drugs in the Yangon area. They reported difficulties in accessing methadone therapy and overdose treatments.  DICs were also important social settings for drug users.  One interviewee described how the DICs provided him with psychological benefits he can no longer access, stating “it was difficult to get counseling, which I really needed.” They felt comfortable meeting friends and counselors with similar struggles.  One interviewee shared that he “lost a place to rest.” Based on these findings, closure of DICs has been devastating for people who use drugs in Myanmar.  One interviewee stated I don’t get needles anymore, so I share with others. I don’t know where to [get] blood testing. I am worried that I could be infected by blood-borne diseases. I can’t control my desire to use drugs.”

However, inspired by needs articulated in interviews, YET has developed a plan to create its own harm reduction program with wide-ranging services such as clean needle distribution, risk-reduction education, and testing for sexually transmitted infections (STIs) including HIV.  YET encourages donors and the government to make efforts to reopen centers like DICs for the crucial medical, psychological, educational and social benefits they provided to vulnerable people who use drugs in need.  Notably however, CBOs such as YET engaging in outreach programs face the possibility of arrest and harassment by police.  For the most meaningful change to occur in reduction of drug-use-related harms including HIV and overdose, draconian laws against drug use must be reformed and people who use drugs should be decriminalized.

Looking Ahead

Myanmar has made significant strides in the post-military junta era in addressing healthcare, such as establishing Universal Health Care, which includes a Basic Essential Access to Health Services Package.[14]  It has also committed to addressing the HIV crisis through programs such as comprehensive sex education for Myanmar’s youth population[15] and a five-year strategic plan aimed to end HIV as a public health threat by 2030.[16]  However, data from interviewees confirm that key populations still face significant barriers to universal access to HIV services and other rights.  On April 29th, 2019, President Win Myint’s spokesperson, U Zaw Htay, stated that Myanmar’s drug policy would be to rehabilitate and reintegrate people who use drugs into society.  Reflecting a rehabilitative approach, Htay noted that people who use drugs need assistance instead of punishment.[17]  Gains are being made regarding HIV law and policy as well.  A bill designed to help people living with HIV, prevent new cases of HIV, eliminate discrimination on the basis of HIV status, and increase access to healthcare for people living with HIV, which has been in the drafting process since 2014, is about to be finalized.[18]  The political transition, the passage of progressive and transformative bills, and the introduction of new bills can help create more robust civil society, improved public health, and expand access to rights for all in Myanmar.

The grassroots groups we supported through our Human Rights Documentation and Advocacy Project continue to reap benefits from the training provided.  Based on recent feedback from interviewees, RHAM is distributing condoms to sex workers in Yangon. It is also engaging in an outreach program to interview more sex workers about their experiences accessing healthcare for the prevention and treatment of HIV and STIs.  MPWN has worked closely with local service providers from the Myanmar Ministry of Health and Sports.  MPWN representatives presented their interview findings, developed a regional strategy plan for improved access to healthcare, and discussed how the Ministry and CBOs can coordinate further in the future to meet the needs of women living with HIV. MPWN also advocated to medical service providers to end mistreatment of people living with HIV by medical personnel and establish mechanisms to ensure appropriate interactions. YET has been providing clean needles to people who use drugs and advocating to local team leaders in the Ministry of Health and Sports for the need to reopen spaces where people who use drugs are treated with dignity and can avail themselves of evidence-based harm reduction interventions without discrimination. In addition to advocacy at the local level, YET also presented its interview findings at a National Harm Reduction forum in December 2018.

Despite these critical lifesaving advancements, without investment in groups like MPWN, RHAM, and YET, Myanmar’s traction and gains for its civil society will wither, goals will not be met, and its people will unnecessarily and unjustly suffer. Given the success of our rights training programs, more groups than ever are requesting to take part. We plan to expand our capacity to respond to increasing demands for our training programs through staffing up and investing more in local leadership and coalition-building to improve sustainable civil society advocacy.   For more information on how to help these groups continue to perform their crucial work, please visit www.asiacatalyst.org or contact info@asiacatalyst.org.

 

References and Quotations

[1] “Timeline: Reforms in Myanmar.” BBC News. July 08, 2015. Accessed June 19, 2019. https://www.bbc.com/news/world-asia-16546688

[2] “HIV and AIDS in Myanmar.” AVERT. January 18, 2019. Accessed June 19, 2019. https://www.avert.org/professionals/hiv-around-world/asia-pacific/myanmar.

[3] Ibid.

[4] “Myanmar.” UNAIDS. June 14, 2019. Accessed June 19, 2019. https://www.unaids.org/en/regionscountries/countries/myanmar.

[5] Unaids.org. “Myanmar Launches New HIV Strategic Plan.” UNAIDS. May 19, 2017. Accessed June 19, 2019. https://www.unaids.org/en/resources/presscentre/featurestories/2017/may/20170519_myanmar.

[6] Ibid.

[7] Ibid.

[8] Ibid.

[9] UNAIDS defines key populations as “gay men and other men who have sex with men, sex workers and their clients, transgender people, people who inject drugs and prisoners and other incarcerated people as the main key population groups. These populations often suffer from punitive laws or stigmatizing policies, and they are among the most likely to be exposed to HIV. Their engagement is critical to a successful HIV response everywhere—they are key to the epidemic and key to the response. Countries should define the specific populations that are key to their epidemic and response based on the epidemiological and social context. The term key populations at higher risk also may be used more broadly, referring to additional populations that are most at risk of acquiring or transmitting HIV, regardless of the legal and policy environment.”  UNAIDS Terminology Guidelines.” UNAIDS. 2015. Accessed June 19, 2019. https://www.unaids.org/sites/default/files/media_asset/2015_terminology_guidelines_en.pdf.

[10] UNAIDS describes harm reduction as “a comprehensive package of policies, programmes and approaches that seeks to reduce the harmful health, social and economic consequences associated with the use of psychoactive substances. The elements in the package are as follows: needle and syringe programmes; opioid substitution therapy; HIV testing and counselling; HIV care and antiretroviral therapy for people who inject drugs; prevention of sexual transmission; outreach (information, education and communication for people who inject drugs and their sexual partners); viral hepatitis diagnosis, treatment and vaccination (where applicable); and tuberculosis prevention, diagnosis and treatment. For example, people who inject drugs are vulnerable to bloodborne infections (such as HIV) if they use non-sterile injecting equipment. Therefore, ensuring adequate supplies of sterile needles and syringes is a harm reduction measure that helps to reduce the risk of blood-borne infections.”  Ibid.

[11] “Myanmar.” UNAIDS. June 14, 2019. Accessed June 19, 2019. https://www.unaids.org/en/regionscountries/countries/myanmar.

[12] Ibid.

[13] More information about drug laws in Myanmar can be found at: Frontier. “Myanmar’s Zero-tolerance Drug Policy Is Doomed to Fail.” Frontier Myanmar. January 28, 2019. Accessed June 19, 2019. https://frontiermyanmar.net/en/myanmars-zero-tolerance-drug-policy-is-doomed-to-fail.

[14] Tea Circle Oxford, Elliot Brennan. “Myanmar’s Public Health System and Policy: Improving but Inequality Still Looms Large.” Tea Circle. August 30, 2017. Accessed June 19, 2019. https://teacircleoxford.com/2017/08/30/myanmars-public-health-system-and-policy-improving-but-inequality-still-looms-large-2/.

[15] Unaids.org. “Positive Health, Education and Gender Equality Outcomes for Myanmar Youth.” UNAIDS. June 14, 2019. Accessed June 19, 2019. https://www.unaids.org/en/resources/presscentre/featurestories/2019/june/20190614_myanmar-youth.

[16] Unaids.org. “Myanmar Launches New HIV Strategic Plan.” UNAIDS. May 19, 2017. Accessed June 19, 2019. https://www.unaids.org/en/resources/presscentre/featurestories/2017/may/20170519_myanmar.

[17] Htut, Pars Yi. The Myanmar Times. April 26, 2019. Accessed June 19, 2019. https://myanmar.mmtimes.com/news/122549.html.

[18] This update has not been publicized yet.  It was provided to us by our partner, Community Network Consortium (CNC).  CNC is a Myanmar national consortium of nine community-based networks representing people living with HIV and key populations. Its members have been involved in consultations with government officials for current law reform processes.  CNC members have been co-authors of the new HIV bill titled Law related to People living with HIV and Affected Populations.

 

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About the author

Julia K. Klein, J.D. is a research fellow at Asia Catalyst.  Klein is interested in international human rights law and public interest law.  Klein has worked on matters such as health justice for low-income populations in the United States, legal strategies for implementation of sex workers’ rights in Cambodia, and legal strategies for fighting human trafficking in the Mediterranean.  Klein received her Juris Doctor from Duke University School of Law in 2018 and is currently awaiting admission to the New York Bar.