I think twitch embeds their ads. To block there ads you now need to pretend to be in one of the ad-free countries.
These identifiers could be collected automatically by plugins like SponsorBlock in a community effort and then combined together to identify parts which are common for every viewer, i.e. the ones representing the original video content.
In other words, it seems to me that even putting ads directly into a video stream would not prevent people from being able to block these ads.