A major new international study has found that young adults in low- and middle-income countries who are sex workers, gay men, transgender or living with HIV are facing a surge in online abuse - from harassment and blackmail to the non-consensual sharing of intimate images.
Researchers from The University of Warwick's Centre for Interdisciplinary Methodologies warn this abuse is becoming increasingly normalised and is moving between online and in-person threats, with most victims having little access to support or justice.
The study - the largest of its kind - focuses on Colombia, Ghana, Kenya and Vietnam, and reveals how stigma, harassment, digital exclusion and fear are creating major barriers to accessing essential health information and support online for some of society's most marginalised groups.
More than 300 young adults aged 18 to 30, along with 41 experts and leaders from UN agencies, governments, HIV support networks and civil society, were interviewed for the study.
The research was carried out by an international consortium of academics, human rights lawyers, health advocates, young leaders, and community-led organisations, with support from The University of Warwick's Centre for Interdisciplinary Methodologies and funding from Fondation Botnar, a Swiss foundation.
The consortium included the Ghana Network of Persons living with HIV, the Global Network of People Living with HIV, Kenya Legal & Ethical Issues Network on HIV and AIDS, Privacy International (UK), Restless Development, STOPAIDS, Universidad de los Andes (Colombia) and the Vietnam Network of People Living with HIV.
The research comes as the World Health Organization (WHO) reviews its Global Strategy on Digital Health, which aims to help countries integrate digital health tools into their healthcare systems to improve delivery, reduce inequalities and promote health equity. It also follows repeated calls from the UN for online platforms to be regulated to stop the spread of harmful misinformation and abuse, including a Global Digital Compact approved in 2024.
Key findings:
Young adults described a wide range of obstacles to safely accessing health information and support online:
-
Cost and connectivity: In Kenya and Ghana, participants described being forced to choose between buying food or mobile data. Some sex workers and young women fall into debt trying to stay online, cutting them off from both income and essential health support.
-
Stigma and exclusion: In Colombia, some transgender participants say they avoid social media altogether due to frequent harassment. In Vietnam, fear of being "outed" as a person living with HIV has led many to self-censor online.
-
Surveillance fears: Across all four countries, participants fear their online activities might be monitored by their family or community, especially for those who have no choice but to share phones. In Ghana, where a draconian anti-homosexuality bill is progressing through Parliament, young adults fear being reported to authorities if they are identified online as part of a sexual minority
-
Online abuse: Over three-quarters of participants described online abuse against themselves or friends, including stalking, blackmail, extortion, and violent threats, particularly among women, LGBTQ+ individuals and sex workers. Some described how this abuse carries over into in-person encounters and is increasingly seen as a normal part of life. Few who reported abuse were able to access support or see any meaningful action from police, law enforcement or tech companies.
-
Resilience: Young activists described relying on community networks for support and advice, and shared visions for the digital future.
In Ghana, a gay man was ambushed by attackers after being lured through a fake online romantic conversation.
In Vietnam, a young man was blackmailed after hackers sent doctored images to his contacts.
In Colombia, transgender sex workers reported being stalked and attacked after their phone numbers and photos were reposted from one escort site to another without their knowledge or consent.
In Kenya, a young woman said she was evicted at just 14 years old, when a healthcare worker accidentally revealed her HIV status via a text reminder sent to a phone the young woman shared with family.
Many young adults told the researchers that reporting abuse does not help and can even make things worse. In Ghana, one participant said a friend who reported an assault was questioned by police about being in a same-sex relationship.
The UN recognises access to online health information and support as a fundamental part of the right to health. But the study reveals how far this right remains out of reach for many.
Professor Sara (Meg) Davis, the report's lead researcher at The University of Warwick's Centre for Interdisciplinary Methodologies, said:
"The issues we've documented have real consequences, not just for physical health, but for mental wellbeing, access to services, and young adults' futures. We believe in the power of digital health, but this is a wake-up call that governments, UN agencies and others need to hear. Young adults are paying the cost, literally and psychologically, of connecting online so that they can access information and support for their health.
"Recent cuts to Overseas Development Assistance funding in the United States, United Kingdom and Europe mean that global institutions that were at the forefront of this work are faltering, and the likelihood of countries meeting the Sustainable Development Goals is in jeopardy."
Dr. Bernard Koomson, co-author of the report and a postdoctoral fellow at The University of Warwick's Centre for Interdisciplinary Methodologies (CIM), said:
"Young adults in our study are clear that they want to use digital tools to support their health, but not at the expense of their privacy, safety or dignity. Their experiences highlight that government regulation is falling behind the pace of digital innovation."
The growing use of digital technologies in the global HIV response has the potential to advance the right to health-but young people living with and affected by HIV are facing online harms that deepen existing inequalities. This abuse undermines their wellbeing and ability to access digital health services or advocate for their rights."
Mike Podmore, Chief Executive Officer at STOPAIDS
Dr. Catalina Gonzalez, a research scientist at Center for Sustainable Development Goals for Latin America and the Caribbean (CODS), Universidad de los Andes in Colombia,, said:
"Our report calls for a bold reimagining of digital inclusion - one that empowers marginalized voices, protects against harm, and builds a future where technology serves as a force for equity, dignity, and opportunity for all."
Allan Maleche, Executive Director of The Kenya Legal & Ethical Issues Network on HIV and AIDS (KELIN), said:
"Digital health must be grounded in human rights, equity, and inclusion. The Digital Health and Rights Project underscores the urgent need for legal and policy reforms to ensure access, privacy, and protection from tech-enabled abuse, especially for youth and communities living with HIV."
Dong Duc Thanh, Chairman of the Vietnam Network of People living with HIV (VNP+), said:
For young people living with HIV and young key populations, the digital space can sometimes feel unsafe, with risks like stigma, discrimination and breaches of privacy. To make sure technology becomes a source of strength and empowerment for every young person, we must come together to create a digital world that is safe, fair, and inclusive - where every voice is heard, and no one is left behind."
The study calls on health ministries, lawmakers and the World Health Organization, to:
-
Prioritise the right to digital inclusion to tackle health inequality; and ensure health services remain available through both digital and non-digital channels, to avoid excluding those without internet access,
-
Take urgent action against Technology-Facilitated Abuse (TFA), using a survivor-centred approach in which survivors have a central voice in decision-making. Governments must strengthen laws, train law enforcement and hold tech companies accountable through effective regulation,
Invest in youth leadership and civil society by ensuring young adults have a meaningful role in shaping digital health policies and strategies, including the next Global Health Strategy.
The researchers are launching the report at a webinar on 12 May at 2pm UK time. They are also holding an online and in-person panel discussion at the World Health Assembly in Geneva on May 21 with UN agencies and youth leaders.
What’s missing in plant-based nutrition research? A new review explains