The U.S. Supreme Court’s order on Tuesday that President Trump’s ban on transgender troops be allowed to go into effect shows the danger of his administration’s anti-LGBT policies. While we have experienced anti-LGBT policies and neglect from prior administrations and Congresses, the breadth of the current assault is striking.

Trump has rolled back rights and protections that took decades to win. His success on multiple fronts has meant that poorly thought through ideas, such as the ban on transgender troops, have been turned into reality.

The ban was announced in 2017 via a series of tweets, apparently at the behest of the Family Research Council, which was designated an anti-LGBT hate group by the Southern Poverty Law Center in 2010. Despite numerous attempts to implement the 417-character ban via new rules and regulations for the U.S. Departments of Defense and Homeland Security, federal courts have nonetheless blocked it from taking effect. But one of Trump’s primary anti-LGBT tactics paid off for him this week. Without the appointment of Neil Gorsuch and Brett Kavanaugh to the U.S. Supreme Court, both of whom are openly hostile to LGBT rights, the narrow 5-4 order would have failed.

Two years into the Trump Administration, LGBT people and people living with HIV are now much more vulnerable to discrimination in health care, social services, employment, education, and access to basic government services. Additionally, as the ban on transgender troops shows, their ability to participate fully in civic life is also being restricted. While the damage is centered in the United States, it reverberates globally where Trump Administration actions are increasing anti-LGBT and anti-HIV stigma around the world.

Earlier this month, Secretary of State Mike Pompeo attended the inauguration of Brazil’s new president Jair Bolsonaro, who campaigned on a racist, misogynistic, and homophobic platform. (In 2014, in one of those jokes that aren’t jokes, Bolsonaro said that a fellow legislator “does not deserve to be raped because she is very bad, she is very ugly.”) Just prior to the Brazilian election, a transgender woman and a drag queen were both murdered, with the attackers in both incidents invoking Bolsonaro’s name. On his first day in office, Bolsonaro signed an executive order prohibiting the country’s human rights ministry from adjudicating anti-LGBT cases. Despite this, Trump praised Bolsonaro as a “great leader” and Pompeo tweeted out a photo of himself with Bolsonaro thanking him for a great meeting to “reinforce our shared commitment to democracy, education, prosperity, security, and #humanrights.” The diplomatic move marked an effective end to previous U.S. foreign policy that treated LGBT rights as a foreign policy goal, and endangers the safety of LGBT people around the globe. Since 2017, waves of anti-LGBT persecution have been unleashed in Africa, Egypt, Asia, Chechnya, and Russia.

But continuing attempts by the Trump Administration to legalize discrimination under the guise of religious liberty hold the most potential for harm. In January 2018, the U.S. Department of Health and Human Services added a Division of Conscience and Religious Freedom under the Office of Civil Rights. The division was created as a result of a 2017 executive order by Trump directing agencies to expand religious freedom protections for federal employees and others who do not want to provide services for LGBT people based on their beliefs that LGBT people are immoral.

In a deeply cynical twist on the religious freedom already guaranteed by the 1993 Religious Freedom Restoration Act, which protects individuals’ free exercise of religion and harms no one, the new office is seeking to implement a rule that would grant freedom “not to act contrary to one’s beliefs.” The result of such a rule would be to permit federal employees and others who work at institutions that receive federal funding, such as universities, hospitals, and health care centers, to deny service or treatment to LGBT people by claiming that to do so would violate sincerely held religious beliefs or moral convictions. The rule would open the door for health care providers to deny not just general health care services to LGBT people, but also specific services such as STI screening to gay men, fertility treatments to lesbian couples, or gender affirmation treatment to transgender people.

Just halfway through his term, Trump has appointed a slew of religious zealots with strident anti-LGBT views to key positions at the Department of Health and Human Services, the federal courts, and elsewhere. For the first time ever, a true believer from the religious right sits as Vice President, next in line as leader of the free world. These right-wing activists are systematically dismantling pro-equality advances in domestic and foreign policy that have changed lives for the better and harmed no one.

In 2016, as a candidate, Trump pledged, “As your president, I will do everything in my power to protect our LGBTQ citizens.” Since taking office he has done the exact opposite. The damage already done is significant, and the damage to come will take years, if not decades, to unravel.

Sean Cahill PhD is director of health policy research for The Fenway Institute and co-author of the policy brief “Trump Administration continued to advance discriminatory policies and practices against LGBT people and people living with HIV in 2018.”