The impact of online abuse

0:00Welcome to Tech Life on the BBC World Service, the programme about how technology affects all of us around the world. I'm Imran Rahman-Jones, and today we'll be hearing about the particular challenges faced by some marginalised communities in four different countries. The young people that we talk to, many of whom have no other place to go to get health information except online, they wind up falling between the cracks. That's the lead author of a new study looking into the online experiences of such groups, and we'll hear more from her in a second, alongside one of the people who took part in the study from Vietnam.

0:34Then we'll be heading to Ghana to see how their Ministry of Health is using drones to keep up with the deliveries of medical supplies after foreign aid cuts meant some trucks stopped transporting medicine and vaccines across the country. We deliver things like snake antivenom, for instance. So that is something that can't be stored across all small health facilities and is really an emergency product. And a surprising way that might help improve your back pain. while waiting for the bus. An algorithm compares eight spinal reference points and then estimates whether the spine is neutral, flexed or laterally tilted.

1:15All this happens in only 200 milliseconds.

1:38If you've ever sought out advice online, whether it be about health, education or money, then you'll know the benefits of such services. Of course, as long as you stick to the reliable outlets. But for some people seeking help, it's even more complicated. An international study has been looking at the online experiences of young people from some marginalised groups, including sex workers, gay and transgender people and people living with HIV. It concluded they're facing a surge in online abuse. This can range from harassment and blackmail to the non-consensual sharing of intimate images. In a moment, you'll hear more about the study.

2:15But first, I've been speaking to Phong Nguyen, who lives in Vietnam. He's a trans activist and involved in LGBT and HIV issues in the country. And he's helped the organisers shape their research and also took part in it himself. He gave me an example of the online abuse he's faced. When I appear on the newspaper, appear on the interview, the report by the media, some people, they just text to me by Facebook and by message. Some of them was, how could you do that? Little thing about your family, about your mother and father, how would they feel when you come out of the class and when you say these things to the media?

3:00and there was a time my Facebook account was reported to Facebook and they just set it down. And at that time, I needed to create a new account and I used it to now. That's Phong Nguyen, one of the 300 people who took part in the study from four different countries. Its researchers say it's the largest of its kind and say their work reveals how stigma, harassment and digital exclusion create barriers to accessing health information and support for some of the groups who need it the most. The findings have been shared with the World Health Organization. And the lead researcher is Meg Davis, Professor of Digital Health and Human Rights at the University of Warwick in the UK.

3:46I asked her what she set out to find in the study. So this study was really developed in collaboration with civil society activists who are part of advisory committees for UN agencies and big funders of development aid. And they were seeing all of this excitement about tech for good and AI for good and as solutions to all the challenges we face in health with reaching those who are hard to reach. So we set out together to try to understand the realities for young adults in low and middle income countries, especially those who are marginalized, who are living with HIV, sex workers, LGBTQ, to understand how is the digital transformation shaping their human rights, especially their right to health.

4:32So you went with four countries. What were the four countries you picked and why did you pick them? We wound up working in Colombia, Ghana, Kenya and Vietnam. And we selected these through consultation with civil society networks, including networks of people living with HIV. And we were lucky that they picked four countries that represent four different geographic regions. So we really have a basis to compare across very diverse settings. And how did the research work? So this wasn't a big survey that people answered multiple choice questions to. How did your qualitative research work? That's right.

5:09It was qualitative because we wanted to get a little bit deeper than you can get with a survey. We wanted to surface some of the tensions and enable people who are marginalized to feel safe talking about sensitive issues. And so we worked through community led organizations using a participatory action research approach, which is when the people who are being studied participate in designing the study, gathering the data, analyzing the findings and then using the findings for action. And that was the approach we took for this study. And what were some of the kind of broad overall findings that you concluded after this study?

5:47It was really the largest study of its kind. And one of the things we found most concerning is that three quarters of the people who participated described abuse online and abuse that moves from online to offline and back to online, including cyberbullying, stalking, blackmail, extortion, and some quite severe physical abuse, especially reported by sexual minorities and sex workers. So this was a really concerning finding for us because we see this increasing over our previous studies and increasingly normalized. And this means that for many young people that we spoke with are afraid to go online to look for health information or services because they're afraid they'll be outed and that they'll also be targeted for these kinds of harms.

6:33I wonder if you could define what you mean by abuse. What does that look like online? Well, for many of the young people we spoke to, it starts with verbal abuse. So for instance, if we have a young person who goes online and looks for information about HIV, and often they look on social media platforms, they start to get text messages. They might get denounced by other people who say, if you're looking for information about HIV, does that mean you have HIV? And what does that mean about who you are, what kind of person you are? We also had people who weren't even going online, but who were getting, for instance, because they shared phones with family members or partners or friends, their browser search terms or their text messages risked exposing them to family members or friends as people who are living with HIV, as LGBTQ, as sexually active young women.

7:27and that could have devastating results. So one young woman in Kenya told us that she got a text message, well-intentioned text message from her doctor reminding her to refill her prescription for HIV treatment. And this was seen by her sister who shared it with her father who then kicked her out of the home. And this young woman was only 14 years old. We heard many similar kinds of stories where people said that because of the level of abuse that they feel unsafe going online to search for or share information with other people. I wonder if you found, there are obviously four very different countries in different parts of the world, but I wonder, did you find similarities between them?

8:05Were there overall themes that applied to all the countries? There were tremendous differences, but also really striking similarities. So I'd say the biggest difference was between Kenya and Ghana on the one hand and Vietnam on the other, because in Kenya and Ghana, many young people told us they had no Wi-Fi, They couldn't pay for smartphones. They had to share phones. Sometimes they go into debt in order to do it. Whereas in Vietnam, smartphones were widely available. Internet was widely available. And we just didn't hear about the same kinds of challenges. But we also saw some real commonalities, both in terms of the abuse that I've described, which was really consistent, issues with health misinformation and information overload, where there's just so much contradictory health information online that it's hard for a young person or for any of us to know what's true and what we should listen to.

8:56And then the concerns about stigma and the fears of being outed as a person living with HIV or as a key population, that was really consistent across all four countries. So what are some of the recommendations you make? How do you think these people could be protected better? I think it's a complex issue because it's a thing that really requires both governments and tech companies to take action. And governments have been slow and have struggled to figure out how to regulate the digital spaces. And tech companies are increasingly reluctant to engage in any kind of content moderation or any kind of restriction on speech.

9:33And what that means is that the young people that we talk to, many of whom have no other place to go to get health information except online, they wind up falling between the cracks. And that's a situation that has to change. And I think it requires governments and lawmakers to step up and work with young people who have experienced this abuse to understand the problem better and to understand what kinds of solutions would work for them. Some people might say you're talking about marginalized communities. It's kind of self-selecting that they're going to be the ones that experience the most abuse online.

10:07So what do you think you found that is new or that you didn't know before from this study? I think one of the things that was striking was that when we think about technology facilitated abuse or online abuse, we often think about it affecting women and girls. And it does. I think what we found is that it not only affects them, but it affects everybody. And when we talk about marginalized groups, they may be the first to experience some of the human rights issues that will affect everybody at some point. And so it's worth our while to try to develop approaches that are inclusive, because if we don't reach those who are most marginalized with health services and information that's going to affect the health of everybody.

10:45That's Professor Meg Davis of the University of Warwick in the UK.

11:03You're listening to Tech Life on the BBC World Service. I'm Imran Rahman-Jones. As always, we love hearing from you on anything we've been covering in recent weeks. Last week, Chris and Graham were chatting about the end of video call service Skype, which was retired recently by Microsoft. Regular listener Jeff Elvis-Tarnu from Monrovia in Liberia sent us a message on WhatsApp and he said he was wowed by Skype when he first used it in 2006, saying it felt like magic. In later years, though, he says it became much less accessible. As a blind user, Jeff uses a screen reader to help him navigate.

11:38but he says it will still be missed. Thanks Geoff as always. We've also been hearing from lots of listeners about the everyday tech they can't do without. A really popular one is something to help quieten the outside world from time to time. Sandy Story lives in Ankara in Turkey and he says he has active noise cancelling headphones. He told us on WhatsApp where I live there's some road traffic and I find it soothing to put on my headphones and cancel out background noise late in the evening or when I take a stroll around the block. This helps create some inner peace, something we can all do with Sandy, I think.

12:13Thanks for your message. And I had to get this one in from another listener, Jeff, who's in China. He says his life has been regulated for 43 years by his Casio digital watch, and he's only had to replace it once in all that time. He says, I couldn't have kept up a lifetime of punctuality and reliability without it. Well, as a proud owner of the same model myself, Jeff, there's that familiar sound. I couldn't agree more. These things are basically indestructible. So tell us about your essential everyday tech. We're on WhatsApp on plus 44 330 1230 320 or email us on techlife at bbc.co.uk. Still to come, the Big Tech Bus Stop Backstoop solution.

13:00It's an awareness tool. It's an advertising tool. But it can really alert you and give you red flags that something is maybe wrong and that you should go for a professional physiotherapist checkup.

13:21On to Ghana next, where the impacts of cuts to foreign aid from the U.S. Agency for International Development, or USAID, continue.

13:35The shockwaves unleashed by the Trump administration's decision to freeze billions of dollars in foreign aid are still being felt as countries reliant on the money consider what to do next. The money went to funding health and education, and it has been a mainstay for many countries for many years. that's all gone now. So what next? That was the BBC's focus on Africa a couple of months ago. And in Ghana, what next was finding another way to transport medicines and vaccines around the country. So the Ghanaian government scaled up an existing deal it had with a drone company called Zipline. That's meant medical shipments which were being done by USAID-funded trucks are now being transported by autonomous drones across the country.

14:21Over the past two months, Zipline has increased operations in Ghana by up to 50%. I spoke to head of Zipline Ghana, Daniel Kweku-Murki, and asked him to start by explaining what the company does. Zipline is a global company operating currently in seven countries. In Ghana, we have been operating since 2019. We have been working very closely with the Ministry of Health, with the Ghana Health Service. through our system, which I would describe as a piece of infrastructure that combines centralized warehousing with aerial logistics, was initially under vaccines. During COVID, we flew a significant amount of COVID vaccines into hard to reach remote areas across Ghana.

15:06How big are your drones and how far can they go? How far can you get them? Yeah, it's like they can fly maximum 250 kilometers. But normally what we do is maybe around, let's say, 110 kilometer radius and then back. And I think in areas like in Ghana, where you have like remote areas with access challenges from being on an island towards road networks and everything, it really makes it accessible within 15 to 45 minutes, irrespective of where you are. I mean, we deliver things like snake antivenom, for instance. So that is something that can't be stored across all small health facilities and is really emergency product.

15:47And is it just medical supplies you move around or is there other products as well? I mean, in Ghana, it's really predominantly medical supplies, but there's other opportunities. And we even recently had the Minister for Innovation from Ghana at our distribution center, and he spoke about expansion into agricultural use cases. So What are some of the technological challenges that you face by running the infrastructure on the ground and also the distribution? I mean, there's definitely challenges in the sense that we have to really optimize it for the respective medical commodity. So, for instance, as an example, we flew the Pfizer vaccine.

16:33So we had to collaborate with them in order to like not just how it is stored, but how is it packaged during the flights? and we drop it off with a parachute to ensure, yes, it doesn't shake too much, everything is in accordance. So we really test for all the products that we have and ensure that storage is optimized during the flight process, it's optimized. But then when you think about it from a system level, I mean, having a centralized warehouse that we have gives the opportunity to really store all those products at the best possible conditions versus having different health facilities in rural areas, in remote areas that cannot have the full infrastructure.

17:17So it's really an opportunity to actually, in quotes, circumvent the challenges in terms of storage. The USAID cut a lot of its services overseas in the last couple of months. How has that affected your business? Have things changed since then? Once the stop order came, there were challenges, especially in the northern, the northeastern, and the eastern region. And so ZipLine stepped in to support those regions. So we basically picked up those deliveries in those three regions and delivered them at no incremental cost to government. So we executed that under our existing contract. So definitely there were challenges.

18:00But on the other hand, because there was a system with Zipline that the Ghanaian government could use, that was an opportunity for us to really work closely together and kind of use this new modern system under, I would say, extreme pressure. Previously, USAID funded deliveries that you've taken over. Were they done not by drone or were they were they done by other transport? That was ground logistics and basically with trucks. But what you can do with a zipline is, for instance, fly out a certain amount and then keep the other one still in the centralized warehouse. And then when the facility runs out of the stock, you can then send the additional one they require.

18:41And whilst doing that, you kind of reduce the wastage in the overall system because you keep it in the right storing conditions. For instance, one big thing that we were delivering is malaria medicines. There was also certain pain medications and other ones that we delivered. You mentioned that the amount of stock that you're delivering now has gone up significantly in the last couple of months. You said that the Ghanaian government does not have to pay more for this. So how does that work? Because I assume your costs have gone up in that time. I mean, we have a contract with the Ministry of Health that is kind of is a flat fee.

19:15and what it does with the monthly flat fee that they are paying. And under that, there is unlimited deliveries for critical commodities. So that's why there was no incremental cost to the government. There's, of course, increased cost or demands on us. But at the same time, we have six distribution centers in Ghana. So we were able to move around some of our capacity, beat human resources, beat batteries, beat the drones or the zips. and ensure that we could scale up and meet their demands in a short time. Daniel Kweku-Murki there. We did contact the US and Ghana governments to see if they wanted to comment.

19:56We haven't heard back from the Ghanaian government yet, but a US State Department spokesman said, we're reorienting our foreign assistance programs to align directly with what's best for the United States and our citizens. We are continuing essential life-saving programs and making strategic investments that strengthen our partners and our own country.

20:27And our next stop is Croatia. Standing at the bus stop, waiting for a ride. Well, let's be honest, it can be kind of boring and probably not great for your posture either, especially if, like me, you're stooping down to look at your phone. But in Croatia, an ad campaign means you can check the condition of your spine while you wait for the bus. Digital billboards are being kitted out with technology to scan passengers and look out for problems. Here's a clip from one of their promotional videos. The billboard scans posture and analyses neck, mid and low back in eight points for spinal curvature and thus detecting potential spine problems.

21:07Davor Bruketa is creative director of the advertising agency Bruketa, Anzhinic & Gray in Zagreb, who ran the project with two other partners. He told me all about the billboards. It's not very complicated because a wide-angle camera captures a video when someone is within two metres from the device. And we have on-device computer vision software that extracts a figure silhouette in real time without recording the face, which is very important. And then an algorithm compares eight spinal reference points and then estimates whether the spine is neutral, flexed, or laterally tilted. All this happens in only 200 milliseconds with no physical contact or no data sent to the cloud.

21:58And so the technology is a camera, and what else is involved? I would see my posture and then some kind of prompt telling me what I need to do? Yes, you have to stand still for a few seconds in front of the billboard, and then it scans your posture. And when you interact with the billboard, the system highlights on your back specific points along the spine using green and red markers. And these markers indicate the exact areas where posture potential irregularities or issues are detected. And then in the right corner of the billboard, you have the infographic that offers an overall assessment of your posture expressed as a percentage.

22:47and alongside with insights into your neck position, your shoulder alignment, your upper spine posture, your lower spine posture and your pelvis position. Are these meeting kind of professional medical standards? Yes, it was developed together with physiotherapists from Croatia Polyclinic. I must point here, this is not a medical diagnostic tool. It's a awareness tool. It's an advertising tool. But it can really alert you and give you red flags that something is maybe wrong and that you should go for a professional physiotherapist checkup. And so say I was scanned and there was a problem detected with my posture.

23:33What would then happen? It advised me to go to the physiotherapy company behind the adverts? Yeah. Croatia Polyclinic has their own physiotherapist. If you like, you can, through the QR code, you can schedule a full physiotherapist examination. And so we send no data to the cloud. But if you want to check to schedule an examination, you can give us your email and then we do the rest. So we scanned more than 100 ,000 people and we collected 50 ,000 emails GDPR compliant. and we increased the number of examinations by almost 50%. So if people don't want to share their information, they'll have the scan and then that's it, their information is not stored?

24:26Absolutely. It's free. We use the same camera that is found in a mobile phone, so there is no radiation, no laser, no contact. And all computing happens inside the billboard, which is very important to stress. And so no identifiable imagery is stored. It's completely physically or digitally safe. And it shows you the result. And then if you want, you can get a physiotherapist checkup. And for the people that had the worst results, we've been giving these checkups for free. And could it be used for other issues with the body? We've talked about back pain and posture. What else could it possibly be used for?

25:08This is the second project that is using this GoToDigital network. Two years ago, three years ago, we've been scanning people's emotions and how they feel, also promoting this mental health. We had this mental health campaign. In theory, you can read how the city feels every morning in the real time. Is the city happy or sad or stressed? and it can be done without breaching GDPR. Thanks to Davo Brucheta speaking to me from Zagreb in Croatia.

25:47And with that, we've reached the last stop on today's tech life journey. Before you hop off, we've just got time to remind you of our contact details. Get in touch with your everyday essential tech or tell us your thoughts on anything you've heard on the program today by whatsapping us on plus 44 330 1230 320 or you can email us on techlife at bbc.co.uk. Today's Tech Live was produced by Tom Quinn, edited by Monica Soriano and presented by me, Imran Rahman-Jones.