Here's how:
1. In iTunes, sign out of any other accounts you have. (By clicking on your account name in the top right corner, and then selecting "Sign Out".
2. Go to the botton of the page, and choose “United States” for the country.
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3. Go to any free item to download. (A free game in the appstore will work well). Click "Get App".
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4. When prompted to log in, choose “Create New Account”
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7. Fill in some details and click “Continue”. Note you'll need a real valid email address.
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9. You will receive a activation email, click on the link and your account will be activated!
Note, you will only be able to download free content. I you want to buy content you will need to buy a iTunes gift certificate. I think you can find some on eBay, or if you live in the Johannesburg area, I saw that WW Computers in Cresta shopping centre sell some.
Happy downloading!