Toxic content can't be eliminated as long as there is freedom on the internet. It can only be mitigated by responsible image hosts, relay operators, and client devs. Unfortunately the nature of encryption, hash databases, and AI training makes it very hard to really get a handle on illegal content. There is ongoing effort to bring the needed resources to the wider fediverse:

https://about.iftas.org/

The fact is, unfortunately, that any failure to do moderation will be weaponized against freedom technology but not against "compliant" social media — regardless of the actual safety of one or the other.

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Oddly enough I don’t have much to add because you said what I would have said but more eloquently.

I’d only add that as the world moves towards decentralization, advocates, parents/caregivers, and teachers etc should focus on preventing online child sexual exploitation through education and awareness. A strong educational push could at least help to curb the sextortion and SG-CSEM.

It would be helpful if nostr clients added a resource page if someone is experiencing online sexual exploitation. This could be added down the road because I don’t believe that it’s necessary…. Yet.

Example: When someone goes to report CSE on a client, after the report there would be resources available on that page.