Refractions of tuberculosis and migration in the northern suburb of Paris: Exposure, adherence, and semantic recalcitrance.

France is overall a low endemic country for tuberculosis (TB); however, Seine-Saint-Denis-the poorest department of metropolitan France-has the highest incidence rate in the whole country, excluding overseas territories. At the national level, TB mainly concerns people coming from a country with a high endemicity of TB, people in conditions of absolute poverty, and people living in prison facilities. In this north-eastern Parisian suburb, we conducted qualitative research through a multi-sited ethnography in six university hospitals of the Assistance Publique - Hôpitaux de Paris (AP-HP), two inter-municipal hospital centres, and the Samusocial de Paris, Équipe Mobile de Lutte contre la Tuberculose, a mobile medico-social team dedicated to TB. This study examines the processes through which tuberculosis is experienced and interpreted by migrants undergoing treatment in these facilities. Drawing on 82 in-depth semi-structured interviews with people living with TB (65 men and 17 women, whose estimated mean length of residence in France was about 10 years), this study shows that persistent doubt about the biomedical diagnosis can coexist with almost complete adherence to treatment. While most participants follow the prescribed treatment, many do not fully recognise tuberculosis as an exhaustive explanation of their illness and construct aetiological interpretations anchored in the social, material, and institutional conditions of their lives in France, including the absence of stable work and housing, insecure residence status, and experiences of institutional disaffiliation accumulated over time. We define this specific configuration as semantic resistance: a situated and circumscribed form of agency exercised within the therapeutic relationship through the possibility of accepting treatment without necessarily relinquishing one's own interpretation of illness. These forms of resistance can be read as a denunciation and an unveiling of the social and existential conditions within which suffering is experienced.