If you didn't think you were worth caring about in the first place, why would you care if you caught HIV? News that rates of the virus in gay men remain stubbornly high is depressingly predictable. Despite the "it's great being gay in the UK" mantra, people are dying, and not just because of Aids. There is an epidemic of chronic alcohol and drug misuse, fuelled by society's homophobia. It plays out in a gay culture that celebrates obliteration and quick, easy sex. It meets in response the deadening silence of the biggest HIV service provider, which seems too scared to speak the truth.

If you think homophobia has melted away with the introduction of civil partnerships and the like, think for a moment what it's like to be an average 11-year-old kid who has just realised he is gay. Like everyone else, you'll have expected and will have been expected to be straight, to marry, to have kids and do everything mainstream life entails. You'll have learned that being gay is wrong – maybe from your parents, school or politicians, or from religious organisations that condemn you, literally, to hell.

Overloaded with shame, you bury your realisation. Soon, though, other children recognise and react to your difference. If you're able to weather the bullying and come out of your teens alive and don't get married or hide away in the church, you'll most likely come out on the gay scene.

The performance artist David Hoyle has described the gay scene as "the biggest suicide cult in history". He said this a few years ago, before a recent spate of drug deaths in saunas, so I presume he was referring to the apparent culture of self-harm in all its forms.

Gay bars and clubs are just that, and they buckle under the weight of the unrealistic expectation of doing for gay people what society refuses to. A dysfunctional relationship develops with the commercial forces of the gay scene suggesting to a constant supply of deeply shamed people searching for validation and love that they'll find it in shirtless nightclubs, sex clubs and saunas. Is it any wonder that so many of us don't make it through sober?

Amid all this the HIV sector seems terrified to tell it like it is. Influencing behaviour is difficult and no one can take responsibility for putting on a condom other than the individual, but something is amiss. The Terrence Higgins Trust is an important, life-saving organisation, but these figures cannot be seen as anything but a failure for all of us – including the trust. Perhaps nervous of raising bloody murder with the government, which provides the lion's share of its funding, the trust is not talking loudly enough about the damaging ways that many of us – including myself – often live our lives. It should be pointing out the government's woeful lack of support. Instead, the trust sucks up cash that other organisations dealing with the root causes of self-destructive behaviour – such as the gay mental health charity Pace and the gay drugs and alcohol service Antidote – are desperate for. This needs to be talked about.

I don't have to look far to find friends who have had breakdowns, whose partners have committed suicide, or whose lives have been destroyed by depression, alcohol and drugs, not to mention those who are HIV positive.

It isn't like that for everyone, of course. A huge number of gay people are living happy, successful lives and most of us do practise safe sex. But there is a problem: not just for those who regularly get so out of it that we don't know whether we are having safe sex or not, but for the state, and for organisations that are failing to honestly address these root causes of self-destructive behaviour. We need to lobby the government to help sort this mess out – and if anyone, friend or foe, resists, then it's about time they got out of the way.