I don't understand why this is downvoted to (as of my writing) -2. This actually seemed like a pithy response that raised a fascinating twist on the general model. It was a response to Sly saying:

Yet we would say that someone with several STDs would be responsible if they were going around having frequent unprotected sex with several partners. The disease is a result of their own actions.

The interesting part is that a given state can have different "choice and willpower" requirements for getting in versus getting out. This gets you back into the situation described by Holmes of punishing people in order to discourage other people from following their initial behavior, even (in the case of STDs) in the face of the inability of the punished person to "regret their way to a cure" once they've already made the mistake because they actually are infected with an "external agent" that meets basically all the criteria for disease that Yvain pointed out in the OP.