The adherence for the tuberculosis treatment: the mark of stigma in the discourse of nurses

One of the issues considered today as an obstacle for the control of tuberculosis in the world scenario, regards the non-adherence of the patient for the treatment of the disease, resulting in complications to the health of the individual and negative implications for public health. Objective: To analyze the speeches of nurses working in the Family Health Strategy, about the difficulties in adherence to Directly Observed Treatment (DOT) of tuberculosis in the city of Joao Pessoa, state of Paraiba, Brazil. Method : Qualitative study and discursive approach, developed in August and October 2012. Through the technique of interview guided by a semi driven script, thirteen nurses working in the Family Health Strategy were interviewed in the city of Joao Pessoa, state of Paraiba, Brazil. The empirical material produced was analyzed according to the theoretical and methodological device of Discourse Analysis of pecheutiana French line. Results: The discursive analysis made from the textual marks present in the speeches of enunciators indicates that the difficulties in joining the directly observed treatment of tuberculosis in the city of Joao Pessoa, bind to patients, health professionals and treatment. In relation to the patient, the analysis points to discursive formations linked to the stigma, commitment in the treatment and low level of education. As for healthcare professionals, fear of contagion of the disease - reinforced by the stigma - and the transfer of responsibility in caring to other professionals were observed.  Notably, the spoken relapse, in addition to the fear of health professionals themselves in treating the TB patient, reveals the prejudice that runs through the speeches of the subjects in relation to the exposure of the patient and the duration of treatment made in the Directly Observed Treatment modality. Discussion: The effects of produced senses show that nurses relate the difficulties of adherence to directly observed treatment, among other factors, to the fear of acquiring the disease, which affects not only the patients but also the health professionals themselves, provoking discrimination and contributing to justifying the non-adherence to therapy. It is observed that this fear is affiliated to the historical and social memory of the disease, marked by stigma, prejudice, segregation and exclusion. Conclusion: It is not only enough for the medication to be available. Innovative measures should be designed and implemented not only in relation to the qualification of health professionals to run the DOT. The coordination of tuberculosis control in all health management spheres, must be concerned in fighting the stigma, in a way in which it will demystify the prejudices of professionals and enlighten them about the meaning of this treatment modality to control the disease in the current days.