Smith was instrumental to Milk's career as an activist and politician. He organized and managed Milk's campaigns for public office from 1974 to 1977 and his influence was widely in evidence after Milk was elected to the San Francisco Board of Supervisors in 1977. Smith was well known for orchestrating the Coors Beerboycott and putting Milk at the forefront of the issue, creating one of the first public displays of power by the gay community.
There are hundreds of images of Smith, taken by Milk and others, in the Harvey Milk Archives/Scott Smith Collection at the San Francisco Public Library. After being discharged from the United States Navy, Milk spent many hours taking pictures. Smith was his favorite model; sometimes Milk spent entire rolls of film just taking pictures of Smith.
Smith fell into a very deep depression after Milk was killed. He was the executor of Milk's last will and testament.
Smith died from pneumonia on February 4, 1995 at the age of 46.