This week at the 21st Annual International AIDS Convention in Durban, South Africa, researchers released a study indicating they now know a primary driver of HIV infections among Black women: sexual encounters with Black men who have been released from state and federal prisons. With Black women’s primary intimate partners incarcerated at a rate of a whopping 2,724 per 100,000 compared to 1,091 per 100,000 for Latino men and 465 per 100,000 white men—a majority of them due to low-level drug crimes—it is Black women (and by extension Black children) who experience the fallout from HIV right along with the men. Kassandra Fredrique, state director of the New York policy office at the Drug Policy Alliance, sounds off on the deeply tangled web of conditions that make Black women and their families particularly vulnerable to the disease.

We may be pretty good about having the conversation about the Black community and mass incarceration, but we don’t do a good enough job at understanding how drugs, mass incarceration and mass criminalization all work together to create adverse conditions for Black families, particularly Black women, including an elevated risk of contracting HIV.

What we see continuously is that Black women tend to be the group of people that lose out the most in society. They are also among the most invisible [when] we talk about larger societal issues. We see this in the way that we talk about police killings [of Black women]; the way [Black women] are being discriminated against in housing and education, and in being approved or not approved for loans; we see it in the way mass incarceration disrupts Black women’s lives and their families long before a loved one is incarcerated. We see it in the way Black men and women are treated as if they are wards of the state. It’s obvious in the way Black women interact with social services, the way they are drug tested, they way their children are subjected to metal detectors and “zero tolerance” drug policies in school. So why wouldn’t we expect [society] to be silent about new HIV cases among Black women?

The carceral state is failing [Black women], because incarceration is associated with a higher risk of unsafe injection drug use, unprotected sexual contact and incidences of HIV. Incarceration and criminalization also result in disruptions in antiretroviral therapies [among the men they are intimate with] and consistently elevate HIV viral loads and HIV transmission rates, as well increase antiretroviral resistance. And so incarcerated people, who are at higher risk of unprotected sex, are going out into the community and infecting their partners. Sometimes the men don’t know themselves [that they are infected]. But this is confounding because we know for a fact that drug use, as well as sex, is happening “inside,” and yet the carceral state has not been more proactive in ensuring they reduce the risk inside [and when men are released].

And when they get out, what is the conversation like between that woman and that man [within a heterosexual relationship?] What is it like for that woman to ask that man to wear a condom? What are you saying about what he’s been doing “inside”? What are you saying about your trust? What are you saying about your partnership? Your love? There’s a risk in that conversation. There’s risk in saying, “I think we should use condoms, or “I think you should get HIV tested.” Who’s having that conversation really? It is tied into so much stuff around sex, sexuality, prison rape—all these different things that don’t necessarily have to hurt Black women if a stronger health infrastructure existed.

As told to Tomika Anderson, an award-winning freelance writer who has created content for Essence, Ebony, BET and MTV, among others.